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Methods
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This is the outline of the methods for the Prehospital Evidence-based Practice (PEP) program:
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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.
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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.
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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.
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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).
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Definitions:
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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.
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FYI Article: an article
not directly relevant to prehospital or paramedic practice/medical clinical presentations.
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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.
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Canadian Task Force on the periodic health examination (1979). CMAJ ; 121: 1193-1254.
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Goldbloom, R, Battista, RN (1986). The periodic health examination: 1. Introduction. CMAJ; 134: 721-3.
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American Heart Association (2006). Methodology Manual for ACC/AHA Guideline Writing Committees. Retrieved from:
AHA
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Agency for Health Care Policy and Research (1998). Interim Manual for Clinical Practice Guideline Development.
Retrieved from:
EAST
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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
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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
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Phillips B, et al (2001). Oxford Centre for Evidence-based Medicine Levels of Evidence Scale. Retrieved from:
CEBM
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