Abstract
Multiple national organizations have recommended and supported a national investment to increase the scientific evidence available to guide patient care delivered by Emergency Medical Services (EMS) and incorporate that evidence directly into EMS systems. Ongoing efforts seek to develop, implement, and evaluate prehospital evidence-based guidelines (EBGs) using the National Model Process created by a multidisciplinary panel of experts convened by the Federal Interagency Committee on EMS (FICEMS) and the National EMS Advisory Council (NEMSAC). Yet, these and other EBG efforts have occurred in relative isolation, with limited direct collaboration between national projects, and have experienced challenges in implementation of individual guidelines. There is a need to develop sustainable relationships among stakeholders that facilitate a common vision that facilitates EBG efforts. Herein, we summarize a National Strategy on EBGs developed by the National Association of EMS Physicians (NAEMSP) with involvement of 57 stakeholder organizations, and with the financial support of the National Highway Traffic Safety Administration (NHTSA) and the EMS for Children program. The Strategy proposes seven action items that support collaborative efforts in advancing prehospital EBGs. The first proposed action is creation of a Prehospital Guidelines Consortium (PGC) representing national medical and EMS organizations that have an interest in prehospital EBGs and their benefits to patient outcomes. Other action items include promoting research that supports creation and evaluates the impact of EBGs, promoting the development of new EBGs through improved stakeholder collaboration, and improving education on evidence-based medicine for all prehospital providers. The Strategy intends to facilitate implementation of EBGs by improving guideline dissemination and incorporation into protocols, and seeks to establish standardized evaluation methods for prehospital EBGs. Finally, the Strategy proposes that key stakeholder organizations financially support the Prehospital Guidelines Consortium as a means of implementing the Strategy, while together promoting additional funding for continued EBG efforts.
Highlights
The creation of evidence-based guidelines (EBGs) for prehospital care has been described as “a process whose time has come.”[1]. The 2001 publication of the National Emergency Medical Services (EMS) Research Agenda identified a need for a national investment in EMS research infrastructure and the application of scientific evidence to improve patient care.[2]
We summarize the Strategy created by a steering committee from National Association of EMS Physicians (NAEMSP) in collaboration with representatives of 57 other organizations representing all aspects of EMS and prehospital care
The Strategy proposes the creation of a Prehospital Guidelines Consortium (PGC) as a mechanism to facilitate improved communication among organizations working on EMS EBG-related projects, connect stakeholders with researchers, and improve the cohesiveness and efficiency of EBG efforts (Figure 2)
Summary
The creation of evidence-based guidelines (EBGs) for prehospital care has been described as “a process whose time has come.”[1]. EMS medicine is a complex clinical practice involving a variety of environments and a wide range of medical conditions. While the field suffers from a paucity of evidence, substantial advances in EMS research continuously occur and have the potential to markedly improve outcomes.[4,5,6,7] Knowledge translation is a challenging task for individual prehospital practitioners and medical directors. There is limited research on the direct benefits of existing prehospital EBGs, rigorously developed clinical guidelines are widely utilized in other medical fields and have been linked to improvements in patient care.[8,9,10,11,12,13] EBGs do not equate to rigid protocols that lack flexibility for individual EMS systems. In combination with evidencebased performance measures for EMS,[15] the use of EBGs provide a unique opportunity to improve care for time-dependent conditions such as trauma, stroke, myocardial infarction, and cardiac arrest, fostering innovation in managing these and other high-risk conditions
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