A Decade of PAI Protocol P

As a former proofreader in what was once called the “Protocol Standards and Translations” Department, I remember the much-awaited release of the Advanced Medical Priority Dispatch System^™ (AMPDS^™) version 13.0, now over 10 years ago. The version release was described in this IAED Journal article as “the newest wonder of the emergency communications world,” which was no exaggeration.

In nearly 45 years of Advanced MPDS evolution and refinement, version 13 was a largescale warp into the next level of advanced emergency dispatch care.

Among its impactful scope, the updates included a “fast track” to hands-on-chest for rapid DD-CPR (dispatcher-directed) intervention (CPR Pre-Arrival Instructions), clarifying Axioms for the Aspirin Diagnostic & Instruction Tool, revised instructions for taking a pulse, and additions regarding chemical suicide, among others.

Of all the enhancements released in 2015, the addition of Protocol P: Epinephrine (Adrenaline) Auto-Injector Instructions possibly didn’t attract the most attention from users at the time, but this Pre-Arrival Instruction Protocol was undoubtedly a crucially important provision for those affected by severe allergies in life-threatening situations.

Protocol P introduces clear instructions to address patients experiencing an extreme allergic reaction or anaphylactic shock, a life-critical condition. These instructions include positioning the patient, removing the packaging, and using the epinephrine (adrenaline) injector with specific instructions for varying devices including EpiPen^®, EpiPen Jr.^®, Anapen^®, Anapen Jr.^®, Adrenaclick, Auvi-Q, Allerject^®, and generic or unknown brands. (This number just keeps increasing.)

Though these devices come with instructions (and often training devices), Protocol P is clearly an advantage when the user is unfamiliar and often panicked, nervous, or hesitant to use the medication during an evolving emergency, relying on the calming clarity of the Emergency Medical Dispatcher on the line.

After a decade in use, Protocol P received a few updates in October 2025 to accommodate new epinephrine nasal spray devices (such as neffy^®) as well as defining CLEAR SYMPTOMS of an allergic reaction. As an additional precaution, patients exhibiting these symptoms are now advised to take epinephrine, even if the medication has not been prescribed directly for them— as these events can turn fatal without appropriate and prompt intervention.

Protocol P is also a great resource for handling the caller’s concerned questions, such as whether expired injectors can be used or non-age specific doses can be given. As written in Protocol P, “Studies show kits 5 to 7 years past their expiration date still had more than 70 percent of effective epinephrine, and kits 2 to 3 years past still had 90 percent left.” Sharing this information can reassure and guide callers to take life-preserving action, yet another way the AMPDS achieves a “Zero-Minute Response Time^™” by supporting and instructing those involved at the scene— until help arrives.