Response protocols: their past, present, and future in Spain

Coordination between levels of health care is a relatively recent phenomenon. Response protocols, which are potentially applicable to all conditions requiring a prompt response, are among the most visible consequences of such coordination The response protocol with the longest history in Spain is the stroke code. Introduced in 1997, this code is now used throughout the country and has improved prognosis in this clinical setting. Some city health care systems have since adopted, with good results, codes for managing nonheart-beating donors or acute myocardial infarction. The code for sepsis, on the other hand, has met with the difficulty that clinical recognition is not high in the first few hours of response by emergency services, and outcomes have therefore suffered. Finally, protocols that might potentially benefit patients with other conditions have not been put into practice for a variety of reasons. Examples are one for acute poisoning and another for managing the agitated patient. It is essential, however, to avoid trying to codify all health care responses given that the agility that codes presuppose would suffer. Furthermore, it is important to bear in mind that health care quality does not depend on whether a code is activated or not; instead, a code is one of many quality-related features to consider in the specific clinical situations that call for one. We believe that the future should focus on consolidating our experience with existing codes and on improving registries. New projects should be suggested and results studied and published. [Emergencias 2011;23:311-318]