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A National Model for Developing, Implementing, and Evaluating Evidence‐based Guidelines for Prehospital Care

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Abstract:



ACADEMIC EMERGENCY MEDICINE 2012; 19:201–209 © 2012 by the Society for Academic Emergency Medicine
Abstract

In 2007, the Institute of Medicine’s (IOM’s) Committee on the Future of Emergency Care recommended that a multidisciplinary panel establish a model for developing evidence‐based protocols for the treatment of emergency medical systems (EMS) patients. In response, the National EMS Advisory Council (NEMSAC) and the Federal Interagency Committee on EMS (FICEMS) convened a panel of multidisciplinary experts to review current strategies for developing evidence‐based guidelines (EBGs) and to propose a model for developing such guidelines for the prehospital milieu. This paper describes the eight‐step model endorsed by FICEMS, NEMSAC, and a panel of EMS and evidence‐based medicine experts.

According to the model, prehospital EBG development would begin with the input of evidence from various external sources. Potential EBG topics would be suggested following a preliminary evidentiary review; those topics with sufficient extant foundational evidence would be selected for development. Next, the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) methodology would be used to determine a quality‐of‐evidence rating and a strength of recommendation related to the patient care guidelines. More specific, contextualized patient care protocols would then be generated and disseminated to the EMS community. After educating EMS professionals using targeted teaching materials, the protocols would be implemented in local EMS systems. Finally, effectiveness and uptake would be measured with integrated quality improvement and outcomes monitoring systems.

The constituencies and experts involved in the model development process concluded that the use of such transparent, objective, and scientifically rigorous guidelines could significantly increase the quality of EMS care in the future.

Document Type: Research Article

DOI: http://dx.doi.org/10.1111/j.1553-2712.2011.01281.x

Affiliations: 1: From the Department of Emergency Medicine, University of Calgary (ESL), Calgary, Alberta, Canada; the Arizona Emergency Medicine Research Center, College of Medicine, University of Arizona (DWS), Tucson, AZ; the Department of Emergency Medicine, University of Manitoba (ZJO), Manitoba, Canada; the Office of Emergency Medical Services, National Highway Traffic Safety Administration (CSG, DED), Washington, DC; the Department of Emergency Medicine, Oakland University/William Beaumont School of Medicine (RAS), Rochester, MI; and the Division of Injury Response, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, and Department of Emergency Medicine, Emory University School of Medicine (RCH), Atlanta, GA. 2: From the Department of Emergency Medicine, University of Calgary (ESL), Calgary, Alberta, Canada; the Arizona Emergency Medicine Research Center, College of Medicine, University of Arizona (DWS), Tucson, AZ; the Department of Emergency Medicine, University of Manitoba (ZJO), Manitoba, Canada; the Office of Emergency Medical Services, National Highway Traffic Safety Administration (CSG, DED), Washington, DC; the Department of Emergency Medicine, Oakland University/William Beaumont School of Medicine (RAS), Rochester, MI; and the Division of Injury Response, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, and Department of Emergency Medicine, Emory University School of Medicine (RCH), Atlanta, GA.

Publication date: February 1, 2012

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