GFES adopts new, more rigorous protocols to improve patient care

Great Falls Emergency Services recently rolled out new protocols aimed at providing better patient care.

The ambulance company is regulated by the Board of Medical Examiners in the Montana Department of Labor and Industry and the state has protocols that everyone defaults to.

Justin Grohs, GFES operations manager, said that the state protocols are generic, but put a lot of responsibility for quality on the local agency, especially the medical director, for training and quality assurance.

GFES responds to about 8,000 calls annually in Cascade County and the surrounding region.

[EMS Conference in Great Falls March 24]

A few years ago, staff at GFES started thinking their quality of care could improve if they had more rigorous guidelines.

The team produced detailed protocols that don’t expand their scope of service, which is prescribed by the state, but offer more detail.

The recently adopted protocols at GFES are modeled after those used in Albuquerque, New Mexico and Queensland, Australia.

The new protocols were approved by GFES Medical Director, Dr. Michael Jasumback, and are in accordance with the Montana State Board of Medical Examiners.

The state protocols indicate that local responders could consider administering ketamine, but don’t provide guidance on when to use or in what dosage, Grohs said.


Other areas that the GFES protocols offer more detail include cardiac arrest cases, since they don’t transport all patients to the hospital.


“Our protocols go deeper,” said Sean Burrows, a GFES staffer spearheading training on the new protocols.

“We really spell it out,” Burrows said.

They also include guidance on situations they consider low-frequency, high risk, such as snake bites and breech births.

The state doesn’t include snake bites in their protocols, but GFES added in theirs.


“You need to train more on things you don’t see often,” Burrows said. “So when we do come across it, we’re just as comfortable with it as the things we see frequently. It takes the ambiguity out of it.”

The new protocols are also helpful for new EMTs or paramedics who may not have had the experience to know what to do in some situations. But it also helps the more experienced staff, Grohs said, since there may be multiple ways to handle something, but the protocols are coming from a physician saying this is the best way to do it based on research.

The protocols went into effect early this year and the staff had a meeting to lay them out, Grohs said. Hard copies of the protocols are around the GFES station and the digital versions are on their truck phones. They’ve created a yearlong training program on the new protocols.


“It’s reasonable to say that this will affect the quality of care in a positive way,” Grohs said. “Not that there was a problem, but you can always get better.”