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The North Dakota Department of Health, along with an expert EMS protocol writing committee has developed a set of protocols that all North Dakota ambulance services may choose to use.  These “State Protocols” include every procedure that may be done by EMS Professionals.  The protocols are divided into four broad categories; Advanced Life Support (ALS - Paramedic), Intermediate Life Support (ILS, EMT-I ‘85), Basic Life Support (BLS, EMT), and General Operational Protocols.  Based on your service’s staffing you may only need to utilize one provider level (ALS, ILS, or BLS), or any combination of the three, and the General Operational Protocols.




The EMS Professionals on your particular ambulance service might not be trained or competent to do all of the skills, procedures, or treatments listed; therefore, each individual service and medical director must evaluate each protocol and tailor them for their own use based on the certification or licensure of their staff and their medical director’s requirements.  The medical director for each service has also received a copy of these protocols for reference.  It is up to the ambulance service manager to discuss this process with the medical director and make any modifications required. 


We have included basic visual instructions on how to modify the protocols with a word processor.  In your protocol binder there is a printed “sample” set of protocols and a CD ROM that includes all protocols in an electronic format.  These electronic files are in ‘.rtf’ (rich text format) which makes them easily modified using many types of word processing applications.  Each protocol is included on the CD ROM in two different locations; one as an individual electronic file, and another as part of a logical grouping of protocols.  This was done to make printing your edited protocols simpler. 


There are many ways to modify and make these protocols operational for your service.  We suggest that you:


  1. Take the printed “sample” copy to your medical director to review.  Your medical director can edit the protocols in a manner that he/she sees fit; by lining out skills, procedures or treatments that are not appropriate for your service, denying entire protocols, or by editing the protocols electronically to better suite the capabilities of the service’s personnel.


  1. The manager should then take the printed “sample” protocols that have been edited by the medical director and make the changes electronically if not already done by the medical director.  Change the header to identify your ambulance service’s name on each protocol (see page 3).  You’ll have to save any changes to a local drive on your computer (see page 4).   Make sure to update the table of contents so finding an appropriate protocol is a simple process.


  1. Reprint the edited version and take them back to the medical director for final review and signing (repeat step #2 if needed).  Each protocol must be signed by the medical director to be valid. 


  1. Once signed the protocols are operational.  It is the manager’s responsibility to make sure each EMS Professional is familiar with the new standards and follows them appropriately.   A training session may be required with staff to explain the new standards and procedures.   


  1. Keep the original version of the signed protocols on file and make copies available for everyday use.  Place the everyday version in the binder that was provided using the tabs to group them appropriately.  You may want to consider inserting the pages into page protectors for longevity.

 Word Processing Tips

To edit a protocol, open the document that you wish to modify by double clicking the file name.  Once this is done you may select text by holding down the left mouse button and dragging the cursor across the words you wish to change.  This will “highlight” them for editing (as seen below).

picture 1

Once you have highlighted the text, you may either delete or begin typing.

The next process is identifying your service’s name in the header of each protocol.  Double click in the header area to open up the header and footer edit box.  Highlight “North Dakota Ambulance Service” (by clicking ad dragging as described above) and type in your own service’s name.  You will have to edit each protocol individually.


Picture 2

Once each protocol has been edited, make sure you save the document on a local drive.  This can be accomplished in many different ways and the illustration below shows one way.   Save the file in your word processor’s format like (i.e. ‘.doc’ in MS Word) and title each document as you wish.

Picture 3

Finally when you are done editing, print out the documents and have your medical director approve and sign each protocol.

Remember to save often so your work is not lost in the process.

Funding for this project was provided by the

North Dakota Department of Health-

Division of Emergency Medical Services


Emergency Medical Services for Children Program

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