The DILEMMA Generic Protocol Model (DGPM) is a trans-national ontology of clinical protocols designed using a blend of logic engineering and business modelling techniques, and developed as part of the AIM programme's DILEMMA project. It allows the declarative representation of clinical activities and the knowledge associated with them. It is being used to represent protocols of all sorts - including standards and guidelines - for use in acute, primary, home and shared care. Central to the model are the states that protocol-derived actions can assume, and the statements that must be true before transitions between those states can be proposed. Proposed transitions may then be scrutinised by clinicians, patients and carers, and approved or rejected. This approach enables the model to handle anticipated exception situations, as well as more normal protocol selection and application. Links to multi-media material are being investigated, to enable users to examine the evidence upon which protocols are based, and to provide decision support where deterministic reasoning is not readily available. The model is being discussed with other AIM projects, with a view to developing a European consensus, and generating a version of the model for submission to CEN TC251 as a European pre-normative standard