scholarly journals LO73: The state of the evidence for emergency medical services care of adult patients with sepsis: an analysis of appraised research from the Prehospital Evidence-Based Practice (PEP) program

CJEM ◽  
2019 ◽  
Vol 21 (S1) ◽  
pp. S34
Author(s):  
J. Greene ◽  
A. Carter ◽  
J. Goldstein ◽  
J. Jensen ◽  
J. Swain ◽  
...  
Keyword(s):  
Emergency Medical Services ◽  
Evidence Based Practice ◽  
Adult Patients ◽  
Medical Services ◽  
Evidence Based ◽  
High Quality ◽  
Level Of Evidence ◽  
Moderate Quality ◽  
Emergency Medical ◽  
High Flow Oxygen

Introduction: The Prehospital Evidence-Based Practice (PEP) program is an online, freely accessible, continuously updated Emergency Medical Services (EMS) evidence repository. This summary describes the research evidence for the identification and management of adult patients suffering from sepsis syndrome or septic shock. Methods: PubMed was searched in a systematic manner. One author reviewed titles and abstracts for relevance and two authors appraised each study selected for inclusion. Primary outcomes were extracted. Studies were scored by trained appraisers on a three-point Level of Evidence (LOE) scale (based on study design and quality) and a three-point Direction of Evidence (DOE) scale (supportive, neutral, or opposing findings based on the studies’ primary outcome for each intervention). LOE and DOE of each intervention were plotted on an evidence matrix (DOE x LOE). Results: Eighty-eight studies were included for 15 interventions listed in PEP. The interventions with the most evidence were related to identification tools (ID) (n = 26, 30%) and early goal directed therapy (EGDT) (n = 21, 24%). ID tools included Systematic Inflammatory Response Syndrome (SIRS), quick Sequential Organ Failure Assessment (qSOFA) and other unique measures. The most common primary outcomes were related to diagnosis (n = 30, 34%), mortality (n = 40, 45%) and treatment goals (e.g. time to antibiotic) (n = 14, 16%). The evidence rank for the supported interventions were: supportive-high quality (n = 1, 7%) for crystalloid infusion, supportive-moderate quality (n = 7, 47%) for identification tools, prenotification, point of care lactate, titrated oxygen, temperature monitoring, and supportive-low quality (n = 1, 7%) for vasopressors. The benefit of prehospital antibiotics and EGDT remain inconclusive with a neutral DOE. There is moderate level evidence opposing use of high flow oxygen. Conclusion: EMS sepsis interventions are informed primarily by moderate quality supportive evidence. Several standard treatments are well supported by moderate to high quality evidence, as are identification tools. However, some standard in-hospital therapies are not supported by evidence in the prehospital setting, such as antibiotics, and EGDT. Based on primary outcomes, no identification tool appears superior. This evidence analysis can guide selection of appropriate prehospital therapies.

scholarly journals State of the evidence for emergency medical services care of adult patients with sepsis: an analysis of research from the Prehospital Evidence-based Practice

2021 ◽  
Vol 18 ◽  
Author(s):  
Jennifer Greene ◽  
Judah Goldstein ◽  
Daniel Lane ◽  
Jan Jensen ◽  
Yves Leroux ◽  
...  
Keyword(s):  
Septic Shock ◽  
Emergency Medical Services ◽  
Evidence Based Practice ◽  
Temperature Monitoring ◽  
Adult Patients ◽  
Medical Services ◽  
Evidence Based ◽  
Emergency Medical ◽  
High Flow Oxygen ◽  
Balanced Crystalloids

Introduction The Prehospital Evidence-Based Practice (PEP) program is an online, freely accessible, continuously updated emergency medical services evidence repository. This PEP summary describes the research evidence for the identification and management of adult patients with sepsis or septic shock. Methods A systematic search of the literature on sepsis or septic shock was conducted. Studies were scored by trained appraisers on a three-point level of evidence scale (based on study design and quality) and a three-point direction of evidence scale (supportive, neutral or opposing findings based on the studies’ primary outcome for each intervention). Results One hundred forty-three studies (80 existing and 63 new) were included for 16 interventions listed in PEP for adult patients with sepsis. The evidence matrix rank for supported interventions (n=16) were supportive-high quality (n=2, 12.5%) for crystalloid infusion and vasopressors, supportive-moderate quality (n=8, 50%) for identification tools, pre-notification, point-of-care lactate, titrated oxygen, temperature monitoring and balanced crystalloids. The benefit of pre-hospital antibiotics, colloids, Trendelenburg position and early goal-directed therapy remain inconclusive with a neutral direction of evidence. There is moderate level evidence opposing the use of high flow oxygen. Conclusion Several standard treatments are well supported by the evidence including fluid resuscitation, using balanced crystalloids, vasopressors and titrating oxygen. Tools for identifying and guiding treatment are also supported (eg. pre-notification, temperature monitoring and lactate). The evidence for antibiotic use is inconclusive. This PEP state of the evidence analysis can be used to guide selection of appropriate pre-hospital therapies during the development of pre-hospital protocols or clinical practice guidelines.

scholarly journals Contemporary evidence-based practice in Canadian emergency medical services: a vision for integrating evidence into clinical and policy decision-making

CJEM ◽  
2016 ◽  
Vol 19 (3) ◽  
pp. 220-229
Author(s):  
Jan L. Jensen ◽  
Andrew H. Travers
Keyword(s):  
Decision Making ◽  
Emergency Medical Services ◽  
Evidence Based Practice ◽  
Systems Of Care ◽  
National Level ◽  
Policy Decision ◽  
Medical Services ◽  
Evidence Based ◽  
Emergency Medical ◽  
Patient Health

AbstractNationally, emphasis on the importance of evidence-based practice (EBP) in emergency medicine and emergency medical services (EMS) has continuously increased. However, meaningful incorporation of effective and sustainable EBP into clinical and administrative decision-making remains a challenge. We propose a vision for EBP in EMS: Canadian EMS clinicians and leaders will understand and use the best available evidence for clinical and administrative decision-making, to improve patient health outcomes, the capability and quality of EMS systems of care, and safety of patients and EMS professionals. This vision can be implemented with the use of a structure, process, system, and outcome taxonomy to identify current barriers to true EBP, to recognize the opportunities that exist, and propose corresponding recommended strategies for local EMS agencies and at the national level. Framing local and national discussions with this approach will be useful for developing a cohesive and collaborative Canadian EBP strategy.

scholarly journals P056: The state of the evidence for emergency medical services (EMS) care of blunt spinal trauma: an analysis of appraised research from the Canadian Prehospital Evidence-based Practice (PEP) Project

CJEM ◽  
2016 ◽  
Vol 18 (S1) ◽  
pp. S97-S97
Author(s):  
A. Carter ◽  
J. Greene ◽  
J. Cook ◽  
J. Goldstein ◽  
J. Jensen
Keyword(s):  
Evidence Based Practice ◽  
Spinal Injury ◽  
Spinal Trauma ◽  
Future Research ◽  
Evidence Based ◽  
High Quality ◽  
Level Of Evidence ◽  
Spinal Motion ◽  
Moderate Quality ◽  
Point Level

Introduction: The Canadian Prehospital Evidence-based Practice (PEP) project is an online, freely accessible, continuously updated EMS evidence repository. The summary of research evidence for EMS interventions used to care for blunt spinal trauma is described. Methods: PubMed was systematically searched. One author reviewed titles and abstracts for relevance. Included studies were scored by trained appraisers on a three-point Level of Evidence (LOE) scale (based on study design and quality) and three-point Direction of Evidence (DOE) scale (supportive, neutral, or opposing results). Second party appraisal was conducted for included studies. Interventions were plotted on a 3x3 table (DOE × LOE) for the spinal injury condition based on appraisal scores. The primary outcome was identified for each study and categorized. Results: Seventy-seven studies were included. Evidence for adult and paediatric blunt spinal trauma interventions was: supportive-high quality (n=1, 7 %), supportive-moderate quality (n=3, 21.4%), supportive-low quality (n=1, 7%), neutral-high quality (n=1, 7%), neutral-moderate quality (n=5, 35.7%), neutral-low quality (n=1, 7%), opposing-high quality (n=0, 0%), opposing-moderate quality (n=0, 0%), opposing-low quality (n=1, 7%). One (7%) intervention had no evidence. Interventions with supportive evidence were: steroids, cervical-spine clearance, scoop stretcher, self-extrication and “leaving helmet in place”. The evidence weakly opposed use of short extrication devices. Leading study primary outcomes were spinal motion, diagnostic accuracy, and pressure/discomfort. Conclusion: EMS blunt spinal trauma interventions are informed by moderate quality supportive and neutral evidence. Future research should focus on high quality studies filling identified evidence gaps using patient-oriented outcomes to best inform EMS care of blunt spinal injury.

The emergency medical system

2021 ◽  
pp. 65-75
Author(s):  
Olivier Hoogmartens ◽  
Michiel Stiers ◽  
Koen Bronselaer ◽  
Marc Sabbe
Keyword(s):  
Medical Care ◽  
Emergency Medical Services ◽  
Emergency Medical Service ◽  
Medical Service ◽  
Tertiary Care ◽  
Medical Services ◽  
High Quality ◽  
Emergency Medical ◽  
High Quality Medical Care ◽  
The Moment

The mission of the emergency medical services is to promote and support a system that provides timely, professional and state-of-the art emergency medical care, including ambulance services, to anyone who is victim of a sudden injury or illness, at any time and any location. A medical emergency has five different phases, namely: population awareness and behaviour, occurrence of the problem and its detection, alarming of trained responders and help rendered by bystanders and trained pre-hospital providers, transport to the nearest or most appropriate hospital, and, if necessary, admission or transfer to a tertiary care centre which provides a high degree of subspecialty expertise. In order to meet these goals, emergency medical services must work aligned with local, state officials; with fire and rescue departments; with other ambulance providers, hospitals, and other agencies to foster a high performance network. The term emergency medical service evolved to reflect a change from a straightforward system of ambulances providing nothing but transportation, to a complex network in which high-quality medical care is given from the moment the call is received, on-scene with the patient and during transportation. Medical supervision and/or participation of emergency medicine physicians (EP) in the emergency medical service systems contributes to the quality of medical care. This emergency medical services network must be capable to respond instantly and to maintain efficacy around the clock, with well-trained, well-equipped personnel linked through a strong communication system. Research plays a pivotal role in defining necessary resources and in continuously improving the delivery of high-quality care. This chapter gives an overview of the different aspects of emergency medical services and calls for high quality research in pre-hospital emergency care in a true partnership between cardiologists and emergency physicians.

The Prehospital Emergency Care System in Mexico City: A System's Performance Evaluation

2006 ◽  
Vol 21 (2) ◽  
pp. 104-111 ◽  
Author(s):  
Luis Mauricio Pinet Peralta
Keyword(s):  
Emergency Medical Services ◽  
System Design ◽  
Mexico City ◽  
Emergency Care ◽  
Response Times ◽  
Medical Services ◽  
Prehospital Emergency Care ◽  
High Quality ◽  
Emergency Medical ◽  
Prehospital Emergency

AbstractIntroduction:Mexico City has one of the highest mortality rates in Mexico, with non-intentional injuries as a leading cause of death among persons 1–44 years of age. Emergency medical services (EMS) in Mexico can achieve high levels of efficiency by offering high quality medical care at a low cost through adequate system design.Objective:The objective of this study was to determine whether the prehospital EMS system in Mexico City meets the criteria standards established by the American Ambulance Association Guide for Contracting Emergency Medical Services (AAA Guide) for highly efficient EMS systems.Methods:This retrospective, descriptive study, evaluated the structure of Mexico City's EMS system and analyzed EMS response times, clinical capacity, economic efficiency, and customer satisfaction. These results were compared with the AAA guide, according to the social, economic, and political context in Mexico. This paper describes the healthcare system structure in Mexico, followed by a description of the basic structure of EMS in Mexico City, and of each tenet described in the AAA guide. The paper includes data obtained from official documents and databases of government agencies, and operative and administrative data from public and private EMS providers.Results:The quality of the data for response times (RT) were insufficient and widely varied among providers, with a minimum RT of 6.79 minutes (min) and a maximum RT of 61 min. Providers did not define RT clearly, and measured it with averages, which can hide potentially poor performance practices. Training institutions are not required to follow a standardized curriculum. Certifications are the responsibility of the individual training centers and have no government regulation. There was no evidence of active medical control involvement in direct patient care, and providers did not report that quality assurance programs were in place. There also are limited career advancement opportunities for EMS personnel. Small economies of scale may not allow providers to be economically efficient, unit hours are difficult to calculate, and few economic data are available.There is no evidence of customer satisfaction data.Conclusions:Emergency medical services in Mexico City did not meet the AAA requirements for high-quality, prehospital, emergency care. Coordination among EMS providers is difficult to achieve, due, in part, to the lack of: (1) an authoritative structure; (2) sound system design; and (3) appropriate legislation. The government, EMS providers, stakeholders, and community members should work together to build a high quality EMS system at the lowest possible cost.

Sign in / Sign up

Export Citation Format

Share Document