The Ultimate EMS Protocol

I don’t handle the card much anymore. It stays inside a plastic sleeve in my planner. The edges are worn and the words are faded. It wasn’t printed on kind of paper that travels well in a wallet for twenty plus years. But it’s been worth carrying. It is, quite simply, the ultimate EMS protocol.

I don’t read it often. I’ve read it enough times over the past two decades to have it pretty well memorized. It’s my STAR CARE card.

I got it back when I was a paramedic student at Baystar Ambulance in San Mateo California. It was 1992. I always believed the original author was none-other-than EMS guru Mike Taigman. Mike had signed on to be the quality care guy at the fledgling service and I knew the cards had originated in his office.

The idea was simple. We can’t write a policy for eveything you may encounter in the field. Instead, use this guideline. If the decision you’re about to make passes these eight tests, we support you. NO matter what. Come hell or high water … we have your back.

It’s brilliant really. It’s the policy to end all policies. It’s the grand daddy algorithm. It’s the ultimate protocol.

Fast forward a decade or so. I had been working at a new start-up service in Colorado called Pridemark for afew years and I found myself in the CEO’s office discussing field care and policies. Jeff was a fairly progressive boss and it suddenly struck me that he had never seen my old STAR CARE card.

I said, “Hey check this out.” and I pulled the worn card out of my wallet. He studied it briefly, then smiled. He opened his wallet and pulled out an identical card. Jeff was an old friend of Mike’s since their days together back at Denver General. He’d received his card about the same time I had gotten mine and had also carried it ever since.

Five years and a hundred STAR CARE conversations later I sat in the office of Thom Dick. Thom seemed like he would love the STAR CARE guidelines. They were so in tune to everything he taught as an EMS administrator. I pulled out the card and asked, “Have you ever seen this?” Thom smiled his humble smile and admired my well worn card.

“Yeah”, he replied. “I remember Mike calling me while they were trying to get Baystar up and running. He said he didn’t have time to write a policy manual and wasn’t sure what to do. I scratched this out that night and sent it to him the next morning.”

At long last, the original author of the STAR CARE protocol had been revealed. Thom beamed when he saw his idea still alive and well after so many years. And now it lives on here. The next step in the journey of a brilliant idea.

So you want to know what’s on the card right? OK, here it is … word for word.


STAR CARE Checklist:

The following is a checklist you can use to analyze almost any patient care issue you might encounter. Go through the list in order from top to bottom, and ask yourself if your care meets each criterion. If it does, chances are that you can defend your actions in almost any forum.



Were my actions safe for me, for my colleagues, for other professionals and for the public?



Were my actions taken with due regard for the opinions and feelings of my co-workers, even those from other agencies?


Attentive to human needs

Did I treat my patient as a person? Did I keep him or her warm? Was I gentle? Did I use his or her name throughout the call? Did I tell him or her what to expect in advance? Did I treat his or er family and / or relatives with respect?



Did I act toward my patient, my colleagues, my first responders, the hospital staff and the public with the kind of respect that I would have wanted to receive myself?


Customer accountable

If I were face-to-face right now with the customers I dealt with on this response, could I look them in the eye and say, “I did my very best for you.”



Was my care appropriate – medically, professionally, legally and practically, considering the circumstances I faced?



Did my actions make sense? Would a reasonable colleague of my experience have acted similarly under the same circumstances?



Were my actions fair and honest in every way? Are my answers to these questions?


Almost two decades later, the principals of STAR CARE still ring true. If you want to know if you’re about to do the right thing, look no further. In just about any organization on earth, the principals of this simple acronym will be all you need to defend yourself.


Related Articles:

You Can’t Give Away What You Don’t Have

Quality Assurance In EMS

EMT Basic Skills Are Not Basic

Four Sloppy IV Mistakes That You Should Avoid

Waiting Is Serving


  1. The STARCARE concept was rolled out at my agency a little more than a year ago, but did not really receive acceptance. I think a large part of it was the way that it was explained, and this is a really different perspective of looking at it which makes it much clearer and simpler.

    Thanks for the providing the opportunity to comprehend it!

  2. Steve Whitehead says:

    You’re welcome Dave. I’m sure how it is presented and adopted is going to be critical for its success. I was fortunate to have a leadership team that embraced the idea as more than just a motivational tool. They embodied the idea. And they had great buy-in from the employee group.

  3. heather says:

    i have a question and im not sure if you can answer it for me. last month my father passed away. it happened down at my mom and dad’s place. when it happened my mom called 911 right away. then she tried helping him but was not sure what to do. then she called her sister to see if she knew what to do to help him. then she called me and my sister and we went down to the house. when we arrived my mom was saying that it was too late. he had a heart attack. now my dad was a little bigger guy, so the EMT’S used that as an excuse not to try anything to help him. i would have thought as soon as they got there they should have tryied CPR. expecially since it only took them 17 min to get down to the house. (they were bragging about that). my mom was also begging them to do something to help him, to try anything and they would not try anything. isn’t an EMT suppose to try to help someone, even if they are “gone” if the spouse wants them too?

  4. administrator says:

    So sorry about your father Heather. Sometimes we try to initiate a resuscitation. Sometimes we don’t. It primarily depends on the seven signs of obvious death. (I have a post on that if you search the blog) If signs of obvious death are present then no, it isn’t appropriate to begin resuscitation even when untrained family members demand that we do so. If the body is showing signs of obvious death, that is irreversible. Initiating a resuscitation only gives people false hope instead of letting them begin their grieving process.

    I’ve seen EMTs treat cardiac arrest scenes and family members inappropriately. I’ve also seen family members transfer their grief over the loss of a loved one onto anger at the EMT providers who failed to save them (or initiate a resuscitation.). From my vantage point, it’s impossible to say what happened on the day your father died.

    I get many of these types of storys with requests for my input or judgment. I try not to do that. I only get to hear one side of a very emotional and complex event. Without being there or hearing all of the numerous complex details that influence the call, I just can’t say if our father was treated inappropriately. I’m sorry you didn’t feel the EMTs who responded treated your father correctly.


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  2. […] So is there a place in EMS Culture for providing customer service? I dare say that there is, and I also dare tell you that the person who talks about it most often is actually Steve Whitehead from The EMT Spot. The quest for good customer service in EMS can be found simply by following the Ultimate EMS Protocol. […]

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