What the author inveighs against is a dogmatic misuse of evidence-based medicine, combined with all the nastiness of bureaucracy and the pressure to publish.
JCAHO is a parasite. Papers should not get press releases, and those press releases absolutely should not be reported in non-professional publications. Research is frequently shown to be false, and recentness of publication date should not be used as a proxy for accuracy. These are not new problems he's identifying. By linking them in an article about evidence-based medicine, he's both oversimplifying the issue and identifying the wrong culprit.
The pressure to treat healthcare like other industries is the root of phenomena like JCAHO, the fixation with Press-Ganey scores, and overstandardized "practice guidelines." In addition, bureaucracies, whether public, private, or some godawful hybrid, need standardization. For a healthcare example, think of the NHS's NICE.
The other issue that's been overlooked so far is the relevance of this article to EMS. Vascular surgeons, as the author rightly points out, are rigorously educated professionals who should have the flexibility to make decisions on the basis of their knowledge. This is not nearly as true of paramedics.
EMS works within (not from) protocols because the prehospital environment is different, but more importantly because few prehospital providers are sufficiently educated to make clinical decisions. Standardization of care is, to a point, a good thing in the field and, for that matter, in the hospital. When you're dealing with providers who are largely trained, not educated, and who have limited time and limited supervision, it is absolutely necessary.
Those protocols need to be developed using the best medical knowledge available. Without applicable research, the protocols are little more than working hypotheses (e.g. bicarb as a first-line drug in all arrests). Efficacy and cost-effectiveness research is badly needed for EMS. A narrow set of objections like the ones the author raises are not enough to argue against evidence-based practice and protocol development.
