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The JRCALC Clinical Guidelines

The JRCALC Clinical Guidelines. Dr Iain McNeil Medical Director, Surrey Ambulance Service Associate Medical Director, Kent Ambulance Service. JRCALC guidelines. The need History Where we are now The short term future The medium term future The long term future. JRCALC. The need.

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The JRCALC Clinical Guidelines

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  1. The JRCALC Clinical Guidelines Dr Iain McNeil Medical Director, Surrey Ambulance Service Associate Medical Director, Kent Ambulance Service

  2. JRCALC guidelines • The need • History • Where we are now • The short term future • The medium term future • The long term future Only those who do nothing make no mistakes JRCALC

  3. The need • Public expectations • Clinical Governance • Clinical Audit • benchmarking • Risk Management • Educational base • Evidence base Only those who do nothing make no mistakes JRCALC

  4. History • IHCD training manuals • Individual service guidelines • Staffordshire guidelines • Joint review of “Carney protocols” • ASA/JRCALC effectiveness committee • Department of Health • JRCALC endorsement Only those who do nothing make no mistakes JRCALC

  5. Where we are now • “Carney protocols” now ‘Medical Directors Guidelines’ • NO claim to be perfect!! • Reviewed by JRCALC experts • Endorsed as “interim” • Ready for use in number of services • Agreed starting point for future work Only those who do nothing make no mistakes JRCALC

  6. We MUST overcome prejudices To have a future Only those who do nothing make no mistakes JRCALC

  7. The short term future • National Association of Air Ambulance Services (NAAAS) • IHCD • Medical Directors Group • Meeting December to establish commonality with NAAAS • Merge NAAAS and JRCALC evidence bases Only those who do nothing make no mistakes JRCALC

  8. The medium term future • Merge JRCALC work with NAAAS • Publish on web and CD • Develop audit processes with ASANCEP • Develop evidence base where it is absent • Update in light of evidence • Go through ECC weighting process Only those who do nothing make no mistakes JRCALC

  9. The ECC process • Agree start point • Gather evidence • Determine level of evidence * • Critically evaluate quality of evidence • Summarise the evidence • Determine class of recommendation * • Draft guideline Only those who do nothing make no mistakes

  10. Levels of evidence • Level 1 Randomized clinical trials or meta- analyses of multiple clinical trials with substantial treatment effects • Level 2 Randomized clinical trials with smaller or less significant treatment effects • Level 3 Prospective, controlled, non-randomized, cohort studies • Level 4 Historic, non-randomized, cohort or case- control studies AHA-ECC, Levels of evidence 1998 Only those who do nothing make no mistakes

  11. Levels of evidence • Level 5Case series: patients compiled in serial fashion, lacking a control group • Level 6Animal studies or mechanical model studies • Level 7Extrapolations from existing data collected for other purposes, theoretical analyses • Level 8Rational conjecture (common sense); common practices accepted before evidence-based guidelines AHA-ECC, Levels of evidence 1998 Only those who do nothing make no mistakes

  12. Class of evidence • Class I • excellent evidence: always acceptable • Class II a • good - very good: considered best practice by majority • Class II b • fair to good:considered acceptable alternative by majority Only those who do nothing make no mistakes

  13. Class of evidence • Indeterminate • insufficient evidence or preliminary research evidence • Class III • Harmful, Unacceptable Only those who do nothing make no mistakes

  14. The long term future • Secure funding for evidence base work • Secure funding for ASANCEP • Develop national audit facility • Develop co-ordinated national R&D facility Only those who do nothing make no mistakes JRCALC

  15. Summary • Interim guidelines are ready • Evidence base must be developed • Work must be funded • We must work together to secure a safe future • We must share! Only those who do nothing make no mistakes JRCALC

  16. Any questions? Only those who do nothing make no mistakes JRCALC

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