Cover for Emergency Department Protocol Commons Edition 0.9, featuring a world map graphic, logo, stethoscope, and blue wave design with the subtitle about local adaptation in Caribbean health systems.

Emergency Department Protocol Commons

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A 59-Protocol Framework for Local Adaptation in Caribbean, Small-Island and Resource-Variable Health Systems

Current edition: Consultation Edition, Version 0.9
Publication year: 2026
Editor: Dr Bichara Sahely
Status: Model protocols for professional review and local adaptation

Introduction

The Emergency Department Protocol Commons is a structured collection of 59 model protocols covering the emergency-care journey from arrival, triage and initial stabilization through investigation, treatment, discharge, admission, interfacility transfer, end-of-life care and departmental emergency preparedness.

The collection is intended to support emergency-care teams, hospitals, ministries of health and professional organizations seeking a practical foundation from which locally appropriate emergency-department protocols can be developed.

Particular attention is given to the realities of Caribbean, small-island and resource-variable health systems, where the availability of specialist care, medicines, diagnostic services, blood products, critical-care beds, ambulance transport and regional referral pathways may differ substantially between institutions and jurisdictions.

These documents are offered as a professional commons: a shared starting architecture that can reduce duplicated effort, support regional collaboration and help institutions strengthen reliable access to safe, timely and life-protective emergency care.

The complete collection is organized into nine phases and 59 protocols.

Purpose of the Protocol Commons

The Protocol Commons aims to:

  • Provide a coherent framework for emergency-department clinical and operational practice.
  • Support hospitals that do not yet have a complete protocol library.
  • Make high-quality protocol development more accessible to small and resource-constrained health systems.
  • Encourage multidisciplinary review and local ownership.
  • Support staff orientation, continuing education, simulation, audit and quality improvement.
  • Promote regional learning while respecting differences in law, resources, culture and institutional capacity.

The protocols are not intended to impose a single model of emergency care. Their purpose is to provide a carefully structured foundation that receiving institutions can examine, challenge, adapt and formally approve.

Important Clinical and Governance Notice

These documents are model emergency-department protocols provided for professional education, peer review and local adaptation.

They are not substitutes for:

  • Clinical judgment
  • Current national or professional guidance
  • Specialist consultation
  • Approved institutional policies
  • Local medication formularies
  • Applicable legislation
  • Regulatory requirements
  • Formal hospital governance

Before clinical implementation, each protocol must be reviewed and adapted to the receiving institution’s:

  • Patient population
  • Staffing and professional competencies
  • Medicines and blood-product availability
  • Equipment and monitoring capacity
  • Laboratory and imaging services
  • Specialist and critical-care access
  • Ambulance and transfer arrangements
  • Regional and overseas referral pathways
  • Consent, safeguarding and reporting laws
  • Documentation and information systems
  • Cultural, linguistic and accessibility needs

Each locally adapted protocol must undergo formal approval through the appropriate clinical, nursing, pharmacy, quality, administrative and legal governance processes.

The author and website publisher do not assume responsibility for clinical decisions made through the unreviewed, unapproved or unauthorized use of these materials. Where current local policy, law or authoritative guidance differs from the Commons edition, the locally applicable requirement takes precedence.

How to Use the Protocols

1. Select the relevant protocol

Begin with the protocol that most closely corresponds to the clinical presentation, procedure or departmental issue being addressed.

Many emergencies cross more than one protocol. Teams should use related protocols together where appropriate.

2. Review the clinical content

Confirm that the clinical recommendations remain consistent with:

  • Current authoritative guidance
  • Local standards of practice
  • Available specialist advice
  • Current medicines and dosing references
  • Local laboratory and imaging capabilities

3. Complete the local configuration sections

Every institution should define its own:

  • Emergency telephone numbers
  • Escalation contacts
  • Referral pathways
  • Transfer arrangements
  • Medication concentrations
  • Equipment locations
  • Blood-bank procedures
  • Documentation forms
  • Legal reporting requirements
  • Admission and discharge processes

4. Identify resource gaps

Where the protocol assumes a medicine, test, procedure or specialist service that is not locally available, the adapting team should specify:

  • The safest available alternative
  • The threshold for regional consultation
  • The transfer destination
  • The transport mechanism
  • The staff responsible for initiating transfer
  • The interim stabilization plan

5. Obtain multidisciplinary approval

Local review should involve the relevant combination of:

  • Emergency physicians
  • General practitioners
  • Emergency nurses
  • Pharmacists
  • Paediatric, obstetric, anaesthetic and surgical clinicians
  • Mental-health personnel
  • Laboratory, imaging and blood-bank teams
  • Ambulance and transport services
  • Infection-prevention personnel
  • Quality and patient-safety officers
  • Hospital administration
  • Legal or regulatory advisers where required

6. Educate and prepare staff

Approval alone is not sufficient. Implementation may require:

  • Staff orientation
  • Competency assessment
  • Simulation exercises
  • Equipment checks
  • Medication preparation
  • New documentation forms
  • Transfer agreements
  • Audit measures

7. Monitor and revise

Each protocol should have:

  • A named clinical owner
  • A version number
  • An effective date
  • A review date
  • Defined audit measures
  • A process for reporting problems
  • A process for urgent amendment when safety concerns arise

Protocol Collection

Browse and Download Individual Protocols

View the complete at-a-glance index of all 59 emergency department protocols, with direct links to each PDF consultation copy and editable Word document.

Browse the Emergency Department Protocol Index and Downloads

Phase I — Core Emergency Department Processes and Patient Flow

Protocols 1–12

This phase establishes the operational foundation of the emergency department, including the patient journey, triage, stabilization, documentation, investigations, medication safety, monitoring, consultation, discharge, admission, transfer and clinical handover.

View Phase I — Core Emergency Department Processes and Patient Flow

Phase II — Time-Critical Medical Emergencies

Protocols 13–17

This phase addresses common high-risk presentations requiring rapid recognition and stabilization, including chest pain, respiratory distress, shock, sepsis and altered mental status.

View Phase II — Time-Critical Medical Emergencies

Phase III — Neurological and Cardiovascular Emergencies

Protocols 18–23

This phase covers stroke, seizures, severe headache, transient loss of consciousness, cardiac rhythm disturbance and hypertensive emergencies.

View Phase III — Neurological and Cardiovascular Emergencies

Phase IV — Abdominal, Metabolic and Toxicological Emergencies

Protocols 24–30

This phase covers abdominal and flank pain, gastrointestinal bleeding, vomiting and diarrhoea, dehydration, glycaemic emergencies, acute kidney injury, dangerous electrolyte disorders, poisoning and anaphylaxis.

View Phase IV — Abdominal, Metabolic and Toxicological Emergencies

Phase V — Trauma, Injury and Environmental Emergencies

Protocols 31–37

This phase addresses major trauma, head and spinal injury, thoracic and abdominal trauma, limb injury, burns, wounds, bites, stings, environmental exposure and urgent eye, ear, nose, throat and dental presentations.

View Phase V — Trauma, Injury, and Environmental Emergencies

Phase VI — Maternal, Paediatric and Vulnerable Populations

Protocols 38–47

This phase covers obstetric and gynaecological emergencies, seriously ill children, neonatal emergencies, mental-health crises, safeguarding, older adults, sickle cell disease, immunocompromised patients and dialysis-related emergencies.

View Phase VI — Maternal, Paediatric, and Vulnerable Populations

Phase VII — High-Risk Treatments and Procedures

Protocols 48–50

This phase provides governance and clinical safeguards for emergency airway management, ventilatory support, major haemorrhage, blood products, procedural sedation, analgesia and recovery.

Phase VII — High-Risk Treatments and Procedures

Phase VIII — Complex Disposition and End-of-Life Care

Protocols 51–53

This phase addresses capacity, informed refusal, departure before completion of care, palliative emergencies, treatment ceilings, death in the emergency department and observation or short-stay care.

Phase VIII — Complex Disposition and End-of-Life Care

Phase IX — Departmental Resilience and Operational Safety

Protocols 54–59

This phase addresses infection prevention, outbreaks, emergency-department crowding, mass-casualty incidents, infrastructure and technology downtime, security, violence, missing patients, staff safety, quality assurance, audit, simulation and serious-incident learning.

Phase IX — Departmental Resilience and Operational Safety

Download the Version 0.9 Consultation Edition

The complete Emergency Department Protocol Commons is currently available in two downloadable packages.

PDF Consultation Copies

This package contains stable PDF copies of all 59 protocols for reading, professional review and circulation.

Download the complete PDF Consultation Package

Editable Word Copies

This package contains editable DOCX copies of all 59 protocols to support responsible institutional and jurisdictional adaptation.

Download the complete Editable DOCX Package

Both packages are organized into the nine phases of the Emergency Department Protocol Commons and include:

  • All 59 protocols
  • A master protocol index
  • A README file
  • A file manifest
  • A validation report

These documents are provided as Version 0.9 consultation drafts. They are not approved clinical policies and must not be implemented without independent clinical review, local adaptation, medication and dose verification, legal review where applicable, formal institutional approval, staff preparation and ongoing audit.

To make review manageable, colleagues are encouraged to begin with one phase or a small number of protocols relevant to their area of practice rather than attempting to review the entire collection at once.

All nine phase pages and their individual protocol consultation copies are now available through the Protocol Collection above.

Local Adaptation Checklist

Before adopting any protocol, the local team should confirm:

Clinical relevance

  • Does the protocol apply to the local patient population?
  • Are the recommendations current?
  • Are important local diseases or hazards included?

Staffing and competence

  • Who will perform each intervention?
  • Is the required expertise available at all times?
  • Which procedures require credentialing or supervision?

Medicines and blood products

  • Are the medicines available?
  • Are the concentrations and preparations correct locally?
  • Are antidotes and reversal agents accessible?
  • What blood products can be supplied, and how quickly?

Diagnostics and equipment

  • Which laboratory tests are available?
  • Is imaging available during nights and weekends?
  • Are monitoring, ventilation and paediatric devices available?
  • What alternatives exist during equipment failure?

Referral and transfer

  • Which patients require transfer?
  • Who accepts the referral?
  • How is transport activated?
  • What happens if air or sea transfer is delayed?

Legal and regulatory requirements

  • What consent and capacity rules apply?
  • What safeguarding reports are mandatory?
  • When must police, public health or a Coroner be notified?
  • Who may detain or treat a patient without consent?

Documentation and communication

  • Which paper or electronic forms will be used?
  • How will critical results be communicated?
  • How will receiving teams be handed over to?
  • How will patients receive discharge and safety-netting information?

Governance

  • Who owns the protocol?
  • Who approved it?
  • When does it become effective?
  • When will it be reviewed?
  • Which indicators will be audited?

Version Control

The website edition should be cited using the version displayed on this page.

Suggested citation:

Sahely B. Emergency Department Protocol Commons: A 59-Protocol Framework for Local Adaptation in Caribbean, Small-Island and Resource-Variable Health Systems. Consultation Edition, Version 0.9. Bsahely.com; 2026.

Users should confirm that they are consulting the most recent edition before beginning a new adaptation.

Substantive revisions will be documented in the public change log.

Licensing and Attribution

Except where otherwise indicated, the Emergency Department Protocol Commons is shared under the:

Creative Commons Attribution–NonCommercial–ShareAlike 4.0 International Licence

CC BY-NC-SA 4.0

Users may copy, distribute and adapt the material for non-commercial purposes provided that:

  • Appropriate attribution is given.
  • The original Commons edition is identified.
  • Substantive local changes are clearly stated.
  • The adapting institution and jurisdiction are identified.
  • The adaptation is shared under the same licence.
  • No implication is made that the local adaptation has been endorsed by the original author.

Suggested attribution:

Adapted from Sahely B. Emergency Department Protocol Commons: A 59-Protocol Framework for Local Adaptation. Bsahely.com; 2026. Changes were made by [institution and jurisdiction].

Third-party standards, algorithms, figures or copyrighted materials retain their original ownership and licensing conditions.

Artificial Intelligence Transparency Statement

Generative artificial intelligence assisted with the organization, drafting, editing and synthesis of portions of this protocol collection.

The author directed the work, selected the protocol architecture, reviewed the outputs and accepts responsibility for the decision to publish the materials as consultation drafts.

Artificial intelligence does not replace:

  • Independent clinical verification
  • Multidisciplinary peer review
  • Local legal review
  • Medication and dose validation
  • Institutional approval
  • Ongoing audit and revision

All protocols must be checked against current authoritative sources before clinical implementation.

Feedback and Regional Collaboration

Emergency clinicians, nurses, pharmacists, health administrators, ministries of health and professional organizations are invited to contribute to the continuing development of this resource.

Useful feedback includes:

  • Identification of clinical errors or ambiguities
  • Medication-safety concerns
  • Resource limitations not adequately addressed
  • Small-island transfer and referral challenges
  • Caribbean-specific diseases, exposures or hazards
  • Suggested decision aids or checklists
  • Experience adapting or implementing a protocol
  • Audit findings following local use
  • Updated authoritative guidance

Feedback should identify:

  • The protocol number and section
  • The proposed amendment
  • The reason for the amendment
  • Relevant evidence or local experience
  • The contributor’s professional role and jurisdiction

Submit feedback on the Emergency Department Protocol Commons

A Shared Foundation for Safer Emergency Care

No protocol collection can remove the need for clinical judgment, adequate staffing, functioning health systems or compassionate care.

Protocols can, however, help teams agree in advance on how danger will be recognized, how treatment will begin, how responsibility will be transferred and how patients will be protected when systems are under pressure.

The Emergency Department Protocol Commons is offered in that spirit: not as a finished universal answer, but as a shared foundation from which safer and more locally coherent emergency-care systems may be built.