Bringing Evidence to EMS

Bringing Evidence to EMS

By John Erich Jul 31, 2012

Four years into the quest to develop evidence-based guidelines for delivering prehospital emergency care, the National Highway Traffic Safety Administration has released an update on where it stands.

NHTSA’s Office of EMS and HRSA’s EMS for Children Program have been working with EMS stakeholders since 2008 to create and test a model for developing and implementing such guidelines, which would promote care based on best current scientific knowledge. Its recent timeline depicts what it’s achieved to date and outlines its next steps.

“EBGs are an important element in improving the quality of prehospital care,” NHTSA notes, “as they promote a consistent approach by prehospital providers for a given clinical scenario, and thus facilitate creation of standards for measures to evaluate the quality of prehospital emergency care.” Developing clinical guidelines based on rigorous appraisal of existing evidence is significantly different, the organization adds, from basing care decisions on consensus, convention, opinion or anecdote.

The challenge to develop standard evidence-based prehospital protocols came from the Institute of Medicine’s 2006 Future of Emergency Care series, which included the seminal Emergency Medical Services at the Crossroads report. The first evidence-based guidelines stakeholder meeting followed in 2008, convened by NHTSA and cosponsored by FICEMS (the Federal Interagency Committee on EMS) and the National EMS Advisory Council (NEMSAC).

Those who attended helped inform a draft model process to shepherd development, implementation and evaluation of EMS guidelines. That is built on what NHTSA describes as “an objective and transparent process for appraising the quality of clinical evidence.” That same year, the EMS for Children National Resource Center beta-tested the process to develop a guideline for managing pediatric seizures.

The Children’s National Medical Center (CNMC) further tested the process in drafting guidelines for prehospital pain management and when to call a helicopter for an injured patient. They offered those guidelines to the Maryland Institute for Emergency Medical Services Systems (MIEMSS), which governs EMS in that state. MIEMSS adopted the pain-management protocol for use in Maryland but passed on the HEMS guideline because it was close to its existing protocol, but didn’t require online medical direction for helicopter activation as Maryland does.

Maryland providers were trained on the new pain-management protocol and began using it in 2011, and are now collecting data to evaluate acceptance, compliance and patient outcomes.

Future Plans

Work continues. Before the end of the year, the journal Academic Emergency Medicine will publish a paper describing development of the EBG model process. A final report from the CNMC study, including its guidelines on pain management and helicopter use, will also become available. Separate manuscripts detailing all of the prehospital guidelines developed using the model process will be pitched to top journals. Project leaders will also begin examining processes for implementing EBGs at the state level, and the model process will likely be tweaked to facilitate its adoption and implementation.

For more, see http://www.ems.gov.

As unpredictable mass casualty incidents have been increasingly on the rise, the Stop the Bleed campaign aims to teach citizens how to stop severe blood loss to keep victims alive before first responders can arrive on scene.

There are other, maybe better ways to reach EMS learners.
Metro Atlanta Ambulance Service designed and built an innovative, one-of-a-kind obstacle course to supplement classroom lectures on how to properly operate the stretcher used during EMS transports. 
Firefighters gave students tours of the fire station and taught them life-saving measures to take in the event of a fire.
The Carlisle Regional Emergency Services Program trains students in multiple emergency service specialty areas to help them determine which path they will pursue.
In the wake of the Las Vegas mass shooting that put local hospitals at patient capacity, Charlie Norwood VA Medical Center tested the hospital's skills on handling an MCI.
Fire, EMS and police agencies will be participating in a federally-mandated mock drill involving a plane crash at the Charlotte Douglas International Airport.
The internal audit shows that the trainer didn't file the paperwork correctly, and 12 out of 25 graduates did not pass the paramedics test but were still hired by Atlanta Fire Rescue.
The Prehospital Care Research Forum presents research from EMS World Expo’s International Scientific EMS Symposium.
Changes in practice require the highest possible level of statistical testing.
A new survey reveals providers’ attitudes toward and willingness to perform CP work.
If you’re reading this at EMS World Expo, challenge yourself and step out of your comfort zone.
Two mock deaths in a car and motorcycle collision brought EMS, an air medical crew, firefighters and police to the scene.
EMS personnel, firefighters and police officers took part in a drill evacuating nursing home residents in the event of a fire.
The students, who are experienced firefighters and paramedics in South Korea, traveled to the U.S. in an exchange program to learn about the agency's latest equipment and systems.