Evidence Based Medicine Practices in the EMS Community

EMS Evidence Based Medicine PracticesIn 2001, the National Highway Traffic Safety Administration (NHTSA) sponsored the creation of the National EMS Research Agenda; this document, among other important topics, advised the Emergency Medical Service (EMS) community to apply evidence from scientific research to improve pre-hospital patient care.

In 2006 the Institute of Medicine (IOM) furthered this recommendation by also advocating for evidence based guidelines (EBGs) in its report on the Future of Emergency Care in the United States. These documents led to recent efforts to create a nationally accepted evidence-based guideline model process that will allow EMS to provide scientifically validated, and more effective, pre-hospital care to the American public.

NHTSA and the Health Resources and Services Administration (HRSA) recently sponsored the development of a number of EBGs focusing on topics such as pain management, trauma care, air medical transportation of trauma patients, pediatric seizure management, and pediatric respiratory distress.

In addition to sponsoring the creation of EBGs, NHTSA is exploring the implementation of EBGs at the State level through a cooperative agreement awarded to the National Association of State EMS Officials (NASEMSO) in 2012. As more EBGs are created and are adopted by States and EMS systems, it is critical that a method for tracking their implementation and effectiveness is conceived.

The first step in tracking the implementation and effectiveness of EBGs is to assess the utility of currently available medical data from EMS information systems, States, and the Federal Government. Most States are now participating in the National EMS Information System (NEMSIS), which provides the framework for collecting, storing and sharing standardized EMS patient care data.

Participating States collect and transmit a subset of their data to the National EMS Database, where it is available for EMS stakeholders, researchers and public use. In addition, data not available to the national system may be available in individual State’s individual EMS databases allowing for additional tracking and analysis not available on the Federal database.

NHSTA is now funding a project aimed at:

  • Creating performance measures to assess the implementation and effectiveness of the EBGs over time
  • Determining whether the appropriate data exist in national and State databases to monitor and assess EBG implementation
  • Providing suggestions to State and national database managers that will assist them in modifying databases to improve EBG tracking
  • Creating performance measures for EMS agencies/systems to evaluate their implementation of EBG’s
  • Analyze the currently available data to show the beginning stages of EBG implementation.

The results of this effort will help improve pre-hospital emergency medical care by helping Federal and State EMS stakeholders determine not only the rate of adoption and effectiveness of new EBGs, but it will also help them identify geographic areas where the adoption of EBGs could have the largest impact.

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