Experience with standardized protocols in hypothermia, boom or bane? The Alaska experience

The geography, climate and population of Alaska place practitioners with a variety of skills in the position of initially caring for sick or injured people. The state of Alaska has developed an Emergency Medical Services (EMS) system which is responsible for the training of personnel, equipment, and other aspects of pre-hospital care. In 1982, the EMS produced protocols for the treatment of hypothermia (1). These protocols recommend the specific treatment preferred for each level of skill--from the lay public and first responders through physicians. Revised in 1989, they have been well accepted throughout the state. The protocols have clarified what can be a somewhat confusing subject. The result has been treatment in the field, in smaller clinics, and in hospitals that conforms more to an accepted standard of care-relieving people from having to resolve certain debated aspects of care. A recent survey of prehospital personnel and physicians involved in prehospital care confirmed the usefulness of the protocols.