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Methods
This is the outline of the methods for the Prehospital Evidence-based Practice (PEP) project:
1. Selection of a panel - Physicians were recruited to assist in the review of the literature and to rank the literature according to the parameters established. As much as possible, physicians were assigned particular clinical presentations according to the areas of interest they expressed and their expertise. This was not always possible, and some Appraisers were assigned a clinical presentation that was not taken. Most members of the Appraiser panel are EPs who are members of the Royal College Physicians and Surgeons of Canada, and come from most provinces across Canada.
2. Topic Selection - Through a group consensus, a list of possible clinical presentations and interventions has been developed. These clinical presentations and interventions were based on an amalgamation of existing clinical presentations from other EMS systems.
3. Literature Searching - The coordinator will continuously search the literature for articles that are pertinent to paramedic clinical presentations. This consists of searching literature databases such as PubMed, setting up automatic database searches, and hand-searching reference lists. It is expected that Appraisers will also search for prehospital research relevant to their assigned clinical presentation area. Paramedics and EMS physicians will also be recruited to email references of articles of interest. Articles that are found to be relevant are then sent on to the Appraisers for assessment. Research that is done in the prehospital setting is most ideal, but it is reasonable to include high quality in-hospital studies that are relevant to paramedic interventions.
4. Assessment of Scientific Evidence - Retrieved articles will be sent to the Appraiser who has been agreed to review the literature for that particular clinical presentation. Essentially each clinical presentation will be treated as a critically appraised topic (CAT).

  Definitions:
  Intervention Article: a primary source article, reporting on a research trial on an intervention (does not include diagnosis or prognosis articles). It may be prospective or retrospective in design.
  FYI Article: an article not directly relevant to prehospital or paramedic practice/medical clinical presentations.
Many ranking schemes 8-14 exist that outline how to evaluate the literature. Our Level of Evidence (LOE) scale was derived from a simplified version of the Canadian Task Force Guidelines 8 and the Oxford Levels of Evidence 14, with the intent to be highly useful and pragmatic, for both EMS physicians and paramedics accessing the database. The LOE will appear in our I, II, III scale on the website.

Appraisers use the Individual Study Appraisal Sheet to evaluate each article and assign a Level of Evidence.
  1. Canadian Task Force on the periodic health examination (1979). CMAJ ; 121: 1193-1254.

  2. Goldbloom, R, Battista, RN (1986). The periodic health examination: 1. Introduction. CMAJ; 134: 721-3.

  3. American Heart Association (2006). Methodology Manual for ACC/AHA Guideline Writing Committees. Retrieved from: AHA

  4. Agency for Health Care Policy and Research (1998). Interim Manual for Clinical Practice Guideline Development. Retrieved from: EAST

  5. Fesmire, FM et al (1999). Clinical Policy for the Initial Approach to Patients Presenting with Penetrating Extremity Trauma. Ann Emerg Med; 33: 612-36. Medline

  6. EMSC Partnership for Children/National Association of EMS Physicians Model Pediatrics Protocols (2004). 2003 Revision. Pediatrics Committee, National Association of EMS Physicians. PEC; 8 :343-365 Medline

  7. Phillips B, et al (2001). Oxford Centre for Evidence-based Medicine Levels of Evidence Scale. Retrieved from: CEBM