Each online protocol is able to accept
comments at each decision point (by clicking on the feedback
link); users of the protocols can submit comments as
they learn the protocols or while using them in practice. Our
hope is by having the protocols available to anyone, such
practical feedback will allow iteration of protocols to more
universal consensus. It would be difficult to view ENLS
protocols as guidelines because of this relative lack of
evidence-basis for managing neurological emergencies;
authors of the manuscripts contained herein have referenced
their papers where references exist. ENLS should not, by
itself, be considered standard-of-care, and physicians who
manage patients with conditions addressed by ENLS should
not be considered falling below a standard-of-care if they do
not follow a particular ENLS protocol. Rather, ENLS
should be considered as advisory, much like what a physician
expects to learn when calling a consult. Our hope is that
enterprising researchers will identify the gaps in knowledge
inherent in ENLS and initiate clinical research to prove or
disprove particular components. This research will inform
modification of the protocols over time, increasing their
potential to improve patient outcomes.