Prehospital Evidence Based Practice
Home Introduction PEP Database Methods FAQs What's New PEP Productivity PEP Impact Appraisers Make a Suggestion Cochrane Corner Covid-19 Corner Paramedic Evidence Based Practice Course Emergency Preparedness Corner Links of Interest Contact Us Disclaimer Search Methods Methods schematic Study Appraisal Sheet Direction of Evidence/ Level / Outcomes Intervention Recommendations Guidelines Appraisal Recommendation Changes New Interventions Added Papers Currently Under Review Rapid Reviews State of the Evidence Reviews Presentations Publications Publications Citing PEP Meet our Appraisers Appraiser Login On-Line Course In-Person Course Mini Cat Bank Recent Changes to Recommendations for Interventions   Intervention Nature of Complaint New Recommendation Old Recommendation Date of Change Vector change Cardiac Arrest - VF/VT-Pulseless (Shock Advised) Moderate Supportive Not yet Graded Mar 1, 2023 Tranexamic acid poly trauma including TBI Trauma - Traumatic Brain Injury Moderate Neutral Not yet Graded Feb 27, 2023 Percutaneous Cricothyrotomy Advanced Airway Management - Airway Management (Non-intubation) Moderate Neutral Moderate Against Feb 27, 2023 Hypertension Control Stroke-CVA-TIA - Stroke-CVA-TIA Strong Neutral Strong Supportive Feb 27, 2023 Corsette Style Compression Device (e.g. T-Pod) Trauma - Pelvic Trauma Moderate Neutral Moderate Supportive Feb 27, 2023 Head-up CPR Cardiac Arrest - General Cardiac Arrest Care Moderate Supportive Not yet Graded Feb 19, 2023 Suction Airway Emergency - Foreign Body Obstruction(Complete/Partial) Moderate Supportive Not yet Graded Feb 19, 2023 Blood transfusion Shock (non-septic) - Hemorrhagic Shock Moderate Supportive Moderate Neutral Jan 25, 2023 Advanced Notice/ Optimal Trip Destination Stroke-CVA-TIA - Stroke-CVA-TIA Strong Supportive Moderate Supportive Jan 25, 2023 Screening for Large Vessel Occlusion Stroke-CVA-TIA - Stroke-CVA-TIA Moderate Supportive Not yet Graded Jan 15, 2023 Epinephrine Cardiac Arrest - Post-Cardiac Arrest Care Moderate Neutral Not yet Graded Jan 15, 2023 Norepinephrine Cardiac Arrest - Post-Cardiac Arrest Care Strong Supportive Not yet Graded Jan 15, 2023 Dopamine Cardiac Arrest - Post-Cardiac Arrest Care Strong Supportive Not yet Graded Jan 15, 2023 Screening for Intimate Partner Violence Treat and Release/Refer - Refer Moderate Supportive Not yet Graded Jan 15, 2023 Buprenorphine Toxicologic Emergency - Opioid withdrawal Moderate Supportive Weak Supportive Jan 15, 2023 Oxymetry Monitoring Pediatric Trauma (ABCs/Major) - Pediatric General Trauma Care Moderate Supportive Not yet Graded Dec 15, 2022 Rapid Sequence Induction Advanced Airway Management - Medication for Airway Management Moderate Supportive Moderate Neutral Dec 15, 2022 LMA (without AW reflexes) Advanced Airway Management - Airway Management (Non-intubation) Moderate Neutral Strong Neutral Dec 15, 2022 Crystalloid Infusion Pediatric Trauma (ABCs/Major) - Pediatric General Trauma Care Moderate Neutral Not yet Graded Dec 15, 2022 Midazolam-IV Pediatric Altered Mental State-Dec. LOC - Pediatric Seizure Moderate Supportive Moderate Against Dec 15, 2022 Thoracotomy Cardiac Arrest - Traumatic Arrest Moderate Neutral Weak Supportive Dec 15, 2022 AER (Active External Rewarming) Environmental Emergency - Hypothermic Cardiac Arrest Moderate Neutral Weak Supportive Nov 30, 2022 Identification tools-SIRS Sepsis - Sepsis Syndrome Strong Supportive Moderate Supportive Nov 30, 2022 Identification tools-NEWS Sepsis - Sepsis Syndrome Strong Supportive Moderate Supportive Nov 30, 2022 FAST Trauma - Abdominal Trauma Moderate Supportive Weak Supportive Nov 30, 2022 Chest pain prediction tool Chest Pain - ACS/Suspected Cardiac Origin Strong Supportive Moderate Supportive Oct 30, 2022 Blood transfusion Cardiac Arrest - Traumatic Arrest Moderate Supportive Not yet Graded Oct 30, 2022 Tranexamic Acid Trauma - Limb Amputation/Mangled/Major Hemorrhage Strong Supportive Not yet Graded Oct 3, 2022 Blood Glucose Monitoring Cardiac Arrest - General Cardiac Arrest Care Moderate Neutral Not yet Graded Sep 29, 2022 Point of Care Troponin Chest Pain - ACS/Suspected Cardiac Origin Strong Supportive Moderate Supportive Sep 29, 2022 Ketorolac (Toradol) Trauma - General Major Trauma Care Strong Supportive Moderate Supportive Sep 29, 2022 Temperature Monitoring Trauma - General Major Trauma Care Moderate Supportive Moderate Neutral Sep 29, 2022 Optimal Trip Destination Cardiac Arrest - Traumatic Arrest Moderate Supportive Not yet Graded Sep 10, 2022 Oxygen-high flow Trauma - General Major Trauma Care Moderate Against Strong Supportive Aug 21, 2022 Ketamine Psychiatric - Violent-Agitated Strong Supportive Moderate Supportive Aug 21, 2022 Spinal Precautions Trauma - Spinal Injury Moderate Neutral Weak Neutral Aug 21, 2022 Pressure EENT - Epistaxis Strong Supportive Moderate Neutral Aug 21, 2022 Epinephrine Pediatric Allergic Reaction - Pediatric Anaphylaxis Moderate Supportive Weak Supportive Aug 21, 2022 Blood transfusion Pediatric Trauma (ABCs/Major) - Pediatric General Trauma Care Moderate Supportive Weak Supportive Aug 21, 2022 Pelvic Binding Cardiac Arrest - Traumatic Arrest Moderate Neutral Not yet Graded Jul 16, 2022 Acetaminophen IV Chest Pain - ACS/Suspected Cardiac Origin Strong Neutral Not yet Graded Jun 29, 2022 Sedation scale Advanced Airway Management - Medication for Airway Management Weak Supportive Not yet Graded Jun 29, 2022 Identification tools- qSOFA Sepsis - Sepsis Syndrome Strong Neutral Moderate Supportive Jun 26, 2022 Ultrasound Trauma - Chest Trauma Strong Supportive Moderate Supportive Jun 26, 2022 Tourniquet (limb) Trauma - Limb Amputation/Mangled/Major Hemorrhage Strong Neutral Moderate Supportive Jun 26, 2022 HEMS Trauma - Traumatic Brain Injury Moderate Supportive Not yet Graded Jun 24, 2022 Methoxyflurane (Penthrox) Pediatric Trauma (ABCs/Major) - Pediatric General Trauma Care Moderate Supportive Not yet Graded Jun 24, 2022 Oxymetry Monitoring Perinatal Care - Newborn Care Weak Supportive Not yet Graded May 26, 2022 ETCO2 Shock (non-septic) - Hemorrhagic Shock Moderate Supportive Not yet Graded May 12, 2022 ETCO2 Pediatric Cardiac Arrest - General Cardiac Arrest Care Moderate Neutral Weak Supportive Apr 2, 2022 Thoracostomy Cardiac Arrest - Traumatic Arrest Moderate Supportive Weak Supportive Apr 2, 2022 Hydroxocobalamin Toxicologic Emergency - Cyanide Poisoning Weak Neutral Moderate Neutral Apr 2, 2022 POCUS Cardiac Arrest - Traumatic Arrest Moderate Supportive Not yet Graded Mar 30, 2022 Oxygen-titrated Trauma - General Major Trauma Care Moderate Supportive Not yet Graded Mar 27, 2022 Capsaicin Toxicologic Emergency - Cannabinoid hyperemesis Moderate Supportive Not yet Graded Mar 19, 2022 Magnesium Respiratory Distress (SOB) - COPD Strong Neutral Moderate Supportive Feb 23, 2022 Transport to an ECMO capable facility Cardiac Arrest - General Cardiac Arrest Care Strong Supportive Moderate Supportive Feb 23, 2022 Passive leg raise Cardiac Arrest - General Cardiac Arrest Care Strong Neutral Not yet Graded Feb 22, 2022 Hypertension Control Trauma - Traumatic Brain Injury Weak Supportive Not yet Graded Feb 22, 2022 Shock Prediction Tool Sepsis - Septic Shock Moderate Supportive Not yet Graded Feb 22, 2022 Oxygen Trauma - Traumatic Brain Injury Moderate Supportive Not yet Graded Feb 22, 2022 Benzodiazepines Toxicologic Emergency - ETOH Withdrawal Moderate Supportive Strong Supportive Jan 24, 2022 Direct Pressure Trauma - Limb Amputation/Mangled/Major Hemorrhage Moderate Supportive Weak Neutral Jan 24, 2022 Mechanical Intraosseous Insertion Pediatric Cardiac Arrest - General Cardiac Arrest Care Moderate Neutral Moderate Supportive Dec 15, 2021 Epinephrine Shock (non-septic) - Cardiogenic Shock Moderate Neutral Moderate Supportive Dec 15, 2021 Needle Decompression Cardiac Arrest - Traumatic Arrest Moderate Neutral Moderate Supportive Dec 15, 2021 High flow nasal canula Respiratory Distress (SOB) - Respiratory Distress NYD Moderate Neutral Weak Neutral Dec 14, 2021 Dispatcher video assistance Cardiac Arrest - General Cardiac Arrest Care Weak Supportive Not yet Graded Dec 14, 2021 Wound packing Trauma - Limb Amputation/Mangled/Major Hemorrhage Weak Supportive Not yet Graded Dec 14, 2021 IV access Pediatric Cardiac Arrest - General Cardiac Arrest Care Moderate Neutral Not yet Graded Dec 14, 2021 Suction Advanced Airway Management - Airway Management (Non-intubation) Moderate Supportive Not yet Graded Nov 27, 2021 12-Lead ECG Cardiac Arrest - Post-Cardiac Arrest Care Moderate Supportive Moderate Neutral Nov 27, 2021 Mechanical Intraosseous Insertion Cardiac Arrest - General Cardiac Arrest Care Strong Neutral Moderate Neutral Nov 27, 2021 Needle Decompression Trauma - Chest Trauma Moderate Neutral Weak Supportive Nov 27, 2021 NSAIDs Non-Traumatic MSK - Mechanical Back Pain Moderate Supportive Strong Supportive Oct 25, 2021 I-Gel Advanced Airway Management - Airway Management (Non-intubation) Strong Supportive Moderate Supportive Oct 25, 2021 Tranexamic acid for isolated TBI Trauma - Traumatic Brain Injury Strong Neutral Moderate Against Oct 25, 2021 Methoxyflurane (Penthrox) Trauma - General Major Trauma Care Strong Supportive Not yet Graded Oct 25, 2021 TIA Score Stroke-CVA-TIA - Stroke-CVA-TIA Weak Supportive Not yet Graded Oct 24, 2021 Transfer of ECMO patients Respiratory Distress (SOB) - Respiratory Distress NYD Moderate Supportive Weak Supportive Sep 30, 2021 Oxygen-high flow Chest Pain - ACS/Suspected Cardiac Origin Strong Neutral Strong Against Jul 29, 2021 Epinephrine Sepsis - Septic Shock Weak Supportive Not yet Graded Jul 29, 2021 Norepinephrine Sepsis - Septic Shock Strong Supportive Not yet Graded Jul 29, 2021 Dobutamine Sepsis - Septic Shock Weak Supportive Not yet Graded Jul 29, 2021 Dopamine Sepsis - Septic Shock Strong Neutral Not yet Graded Jul 29, 2021 Tranexamic Acid Pediatric Shock - Hypovolemic Shock Moderate Supportive Not yet Graded Jul 28, 2021 IV access Cardiac Arrest - General Cardiac Arrest Care Strong Neutral Moderate Neutral Jul 28, 2021 ALS Trauma - General Major Trauma Care Moderate Neutral Moderate Supportive Jul 15, 2021 Methoxyflurane (Penthrox) Pediatric Burns - Pediatric Burns (fire/flame) Weak Neutral Not yet Graded Jul 15, 2021 Intubation Trauma - General Major Trauma Care Moderate Against Not yet Graded Jul 15, 2021 POCUS for COPD evaluation Treat and Release/Refer - Treat and release Weak Neutral Not yet Graded Jun 30, 2021 Transport to an ECMO capable facility Environmental Emergency - Hypothermic Cardiac Arrest Weak Supportive Not yet Graded Jun 30, 2021 Early epinephrine Pediatric Cardiac Arrest - General Cardiac Arrest Care Moderate Supportive Not yet Graded Jun 26, 2021 Opioid Headache - Headache-Migraine Weak Against Not yet Graded Jun 26, 2021 Fibrinogen concentrate Shock (non-septic) - Hemorrhagic Shock Strong Supportive Not yet Graded Jun 26, 2021 Reduction Trauma - Dislocation Weak Supportive Not yet Graded Jun 26, 2021 Stroke Diagnosis Scales (any) Stroke-CVA-TIA - Stroke-CVA-TIA Strong Supportive Moderate Supportive May 26, 2021 Medical clearance in the field Psychiatric - Depressed Suicidal Moderate Supportive Not yet Graded May 26, 2021 Intra-arrest transport (load and go) Cardiac Arrest - General Cardiac Arrest Care Moderate Neutral Not yet Graded May 26, 2021 Chest Compression devices Cardiac Arrest - General Cardiac Arrest Care Strong Neutral Strong Supportive May 5, 2021 Beta Blockers Chest Pain - ACS/Suspected Cardiac Origin Strong Neutral Strong Supportive May 5, 2021 Morphine Chest Pain - ACS/Suspected Cardiac Origin Moderate Neutral Moderate Against May 5, 2021 Acetaminophen PO Acute Pain - Analgesia Strong Supportive Strong Neutral May 5, 2021 IV Fluid as a cooling agent Environmental Emergency - Hyperthermia Weak Neutral Moderate Neutral May 5, 2021 Bystander CPR Cardiac Arrest - General Cardiac Arrest Care Moderate Supportive Strong Supportive May 5, 2021 Nitrous Oxide Chest Pain - ACS/Suspected Cardiac Origin Strong Neutral Weak Supportive May 5, 2021 Double Sequential Defibrillation Cardiac Arrest - VF/VT-Pulseless (Shock Advised) Strong Neutral Moderate Supportive May 5, 2021 Humidified oxygen Respiratory Distress (SOB) - COPD Weak Neutral Moderate Neutral May 2, 2021 High flow nasal canula Pediatric Respiratory Distress (SOB) - Pediatric Wheeze/Bronchospasm Moderate Supportive Moderate Neutral May 2, 2021 Oxygen Trauma - General Major Trauma Care Weak Neutral Not yet Graded May 2, 2021 Crystalloid Infusion Sepsis - Septic Shock Moderate Neutral Strong Supportive May 2, 2021 Pre-alert (massive transfusion protocol) Trauma - Limb Amputation/Mangled/Major Hemorrhage Moderate Supportive Weak Supportive May 2, 2021 Tourniquet (junctional) Trauma - Limb Amputation/Mangled/Major Hemorrhage Weak Neutral Not yet Graded May 2, 2021 Antiarrhythmic - Class I (Na+ channel blockers) Cardiac Arrhythmia - Stable Narrow Complex Tachycardia Strong Supportive Weak Supportive May 2, 2021 Trauma Team Activation Trauma - General Major Trauma Care Moderate Supportive Not yet Graded May 2, 2021 Therapeutic hypothermia Perinatal Care - Neonatal Resuscitation Weak Neutral Not yet Graded May 2, 2021 Isopropyl alcohol GI-GU-Gyne - Nausea and Vomiting Strong Supportive Not yet Graded May 2, 2021 Ketamine Pediatric Respiratory Distress (SOB) - Pediatric Wheeze/Bronchospasm Weak Supportive Not yet Graded May 2, 2021 Metoclopramide plus diphenhydramine Headache - Headache-Migraine Strong Supportive Moderate Supportive May 2, 2021 Wet/hydrogel dressing Burns - Burns (fire/flame) Moderate Neutral Not yet Graded May 2, 2021 Predictive Tools Treat and Release/Refer - Treat and release Moderate Supportive Not yet Graded May 2, 2021 Mechanical Intraosseous Insertion Pediatric Shock - Hypovolemic Shock Moderate Supportive Strong Supportive May 2, 2021 Hypertonic Saline-Nebulized Respiratory Distress (SOB) - Asthma Strong Supportive Not yet Graded May 2, 2021 Epinephrine-IV Respiratory Distress (SOB) - Asthma Moderate Neutral Weak Neutral May 2, 2021 Flush with > 1L Saline EENT - Foreign Body/Welders Flash/Chemical Splash Eye Moderate Supportive Not yet Graded May 2, 2021 Diphenhydramine Allergic Reaction - Anaphylaxis Moderate Supportive Not yet Graded May 2, 2021 Rapid Sequence Induction Pediatric Advanced Airway Management - Medication for Airway Management Weak Supportive Moderate Supportive May 2, 2021 Antibiotic (open fracture) Trauma - Extremity Trauma Weak Supportive Moderate Supportive Apr 26, 2021 Status epilepticus scale Altered Mental State-Dec. LOC - Seizure (Adult) Moderate Supportive Not yet Graded Mar 31, 2021