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From Evidence to Practice Building the National Model. Andrew Travers MD MSc FRCPC Staff Physician, QE-II Emergency Provincial Medical Director Emergency Health Services Halifax, Nova Scotia. [email protected] From Evidence to EMS Practice: Building the National Model.

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From evidence to practice building the national model

From Evidence to Practice

Building the National Model

Andrew Travers MD MSc FRCPC

Staff Physician, QE-II Emergency

Provincial Medical Director

Emergency Health Services

Halifax, Nova Scotia


Traverah@gov ns ca

[email protected]

From Evidence to EMS Practice: Building the National Model


Conflict of interest

Conflict of Interest

  • No reported financial conflicts of interests to declare.

  • Contributing Author

    • Cochrane Collaboration

      • Airway Review Group

    • International Liaison Committee on Resuscitation

From Evidence to EMS Practice: Building the National Model


Acknowledgements

Acknowledgements

Dalhousie Division of EMS

Dalhousie University

  • Dave Petrie MD

  • Ed Cain MD

  • Jan Jensen ACP

  • Dave Urquhart

  • Corinne Burke

From Evidence to EMS Practice: Building the National Model


From evidence to practice building the national model

Out-of-Hospital Medicine

Prehospital Medicine

Paramedicine

Evidence-Based Medicine

EBP, EBID, EBG, etc.


Objectives

Objectives

  • Systems and processes used in Nova Scotia to develop the Evidence Prehospital Protocol Project Online (EBP3O).

  • Key features, unique advantages, and challenges faced over the past ten years.

  • Provide some recommendations.

From Evidence to EMS Practice: Building the National Model


From evidence to practice building the national model

From Evidence to EMS Practice: Building the National Model


From evidence to practice building the national model

Prehospital

Fibrinolysis

Simulation

Air Medical

Program

Medical

First

Responders

Evidence-Based Prehospital Protocol Project Online

EBP3O

Medical

Communications

Centre

Provincial

Trauma

Registry

Prehospital

Research

Network

Community

Paramedicine


Ebp objectives 1996 present

EBP Objectives: 1996 - present

To appraise EMS body of knowledge.

To stimulate debate and growth towards evidence-based EMS protocols.

To be a resource for the development of local EMS protocols; perhaps with a movement towards "best practice" paramedic protocols.

To be a guide to help recognize opportunities for prehospital research.

To develop a process of using evidence to evaluate practice change

suggestions made by paramedics.

From Evidence to EMS Practice: Building the National Model


Process in concept

Topic Selection

Cone Acad Emerg Med 2007 14 11 1052

Formal

Search

Appraisal

Protocol

Operationalization

Dissemination

Evaluate

Performance

Process: In Concept

Published

Evidence

Evidence

Cultural

Getting

The

Evidence

Straight

Operational

Getting

The

Evidence

Used


From evidence to practice building the national model

EBP3O: Levels of EvidenceSimplified Version of Canadian Task Force Guidelines and Oxford Levels of Evidence

From Evidence to EMS Practice: Building the National Model


Ebp3o class of recommendation canadian task force guidelines

EBP3O: Class of RecommendationCanadian Task Force Guidelines

From Evidence to EMS Practice: Building the National Model


Process in practice

Process: In Practice

Published

Evidence

Cultural

Topic Selection

Operational

Formal

Search

Appraisal

Protocol

Operationalization

Dissemination

Evaluate

Performance


From evidence to practice building the national model

http://emergency.medicine.dal.ca/ehsprotocols

http://www.gov.ns.ca/health/ehs


Loe and cor for ehs protocols

LOE and COR for EHS Protocols

From Evidence to EMS Practice: Building the National Model


From evidence to practice building the national model

Clinical

Paramedic

Administrative

Paramedic

Academic

Paramedic

Evidence-Based

Practice Culture

Culture

Regulator

Contractor

Academic Centre


The ebm cycle paramedic practice

The EBM Cycle & Paramedic Practice

Jan Jensen ACP


Unique aspects

Unique Aspects

  • Regional experience in paramedic driven research & EBM.

    • Annual Research/EBM Conferences and CME

    • Question Banking

      • 250 ‘Paramedic Driven’ Questions

    • Multidisciplinary Working Groups

      • Students, residents, paramedics, EMS Physicians

  • National Occupational Competency Profile (NOCP).

    • EBM and Research Competencies

From Evidence to EMS Practice: Building the National Model


Nocp competencies

NOCP: Competencies


Ebp3o paramedic nomenclature

EBP3O Paramedic Nomenclature

  • EBP ‘Surveillance’ Medics

    • Any medic who finds relevant information (online, journal, news article etc) and puts into EBP3O library.

  • EBP ‘Review’ Medics

    • Any EBM trained medic who formally screens the validity of the information.

  • EBP ‘Decision Editor’ Medics

    • Any medic involved in changing the Class of Recommendation/Level of Evidence ‘Dashboard’ on the Evidence-Based Protocols.

From Evidence to EMS Practice: Building the National Model


From evidence to practice building the national model

Objectives described.

Clinical questions described.

Application to patients described.

Scope

&

Purpose

Completed

Target users defined.

Piloted among users.

Editorial

Independence

Stakeholder

Involvement

Rigour of

Development

Applicability

Systematic searches.

Clear selection criteria.

Clear procedure for

Updating.

Clarity

&

Presentation

Specific & unambiguous.

Different Mx options considered.


From evidence to practice building the national model

Scope

&

Purpose

Weaknesses

Includes individuals from

relevant groups.

Editorial independent

from funding.

Conflicts of interest

recorded.

Editorial

Independence

Stakeholder

Involvement

Rigour of

Development

Applicability

Formulation methods

clearly described.

Explicit link between

evidence &

recommendation.

Expert external review.

Key review criteria for

monitoring and auditing.

Clarity

&

Presentation

Key recommendations

easily identifiable.

Application support tools.


Eb3po other weaknesses

EB3PO: Other Weaknesses

  • A contemporary and generalizable method of ‘grading’ evidence is lacking.

  • Minimal peer review & auditing.

  • Ensuring that protocols remain up to date.

  • Minimal funding of infrastructure.

  • Lack of publications from the EBP3O initiative.

From Evidence to EMS Practice: Building the National Model


From evidence to practice building the national model

Scope

&

Purpose

Future Development

Patient preferences and

views sought.

Editorial

Independence

Stakeholder

Involvement

Rigour of

Development

Applicability

Consideration of side

effects, benefits, risks.

Discussion of

organisational barriers.

Application costs considered.

Clarity

&

Presentation

From Evidence to EMS Practice: Building the National Model


Ebp3o other future directions

EBP3O: Other Future Directions

  • Creation and linkage of ‘online’ and ‘didactic’ basic and advanced EBP course for paramedics with input into the EB3P0.

  • ‘Evidence mapping’.

  • Linkage of protocol compliance/performance with evidence evaluation process.

  • Integration/adaptation into ILCOR, Cochrane, etc.

    • Movement of paramedics into these domains.

From Evidence to EMS Practice: Building the National Model


Closing remarks

  • Include paramedics early – “content experts”.

  • A collaborative, community based model is feasible.

  • Standardised/adaptable prehospital ‘grading’.

  • Optimize evidence search & appraisal process.

  • Address the needs of the end-user(s).

  • Incorporate input from the end-user(s).

Closing Remarks

From Evidence to EMS Practice: Building the National Model


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