Department of Emergency Medicine, University of Calgary, Calgary, Alberta, Canada.
Acad Emerg Med. 2012 Feb;19(2):201-9. doi: 10.1111/j.1553-2712.2011.01281.x.
In 2007, the Institute of Medicine's (IOM's) Committee on the Future of Emergency Care recommended that a multidisciplinary panel establish a model for developing evidence-based protocols for the treatment of emergency medical systems (EMS) patients. In response, the National EMS Advisory Council (NEMSAC) and the Federal Interagency Committee on EMS (FICEMS) convened a panel of multidisciplinary experts to review current strategies for developing evidence-based guidelines (EBGs) and to propose a model for developing such guidelines for the prehospital milieu. This paper describes the eight-step model endorsed by FICEMS, NEMSAC, and a panel of EMS and evidence-based medicine experts. According to the model, prehospital EBG development would begin with the input of evidence from various external sources. Potential EBG topics would be suggested following a preliminary evidentiary review; those topics with sufficient extant foundational evidence would be selected for development. Next, the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) methodology would be used to determine a quality-of-evidence rating and a strength of recommendation related to the patient care guidelines. More specific, contextualized patient care protocols would then be generated and disseminated to the EMS community. After educating EMS professionals using targeted teaching materials, the protocols would be implemented in local EMS systems. Finally, effectiveness and uptake would be measured with integrated quality improvement and outcomes monitoring systems. The constituencies and experts involved in the model development process concluded that the use of such transparent, objective, and scientifically rigorous guidelines could significantly increase the quality of EMS care in the future.
2007 年，美国医学研究所（IOM）的未来急救护理委员会建议一个多学科小组为急诊医疗系统（EMS）患者的治疗制定基于证据的方案建立模型。作为回应，国家紧急医疗服务咨询委员会（NEMSAC）和联邦紧急医疗服务机构间委员会（FICEMS）召集了一个多学科专家小组，审查制定基于证据的指南（EBG）的现行策略，并提出一个用于制定此类指南的模型在院前环境中。本文描述了 FICEMS、NEMSAC 和一个紧急医疗服务和循证医学专家小组认可的八步模型。根据该模型，院前 EBG 的开发将从来自各种外部来源的证据输入开始。在初步证据审查后，将提出潜在的 EBG 主题；对于具有足够现有基础证据的主题，将选择进行开发。接下来，将使用推荐评估、制定与评估分级（GRADE）方法来确定与患者护理指南相关的证据质量等级和推荐强度。然后，将生成更具体、上下文相关的患者护理协议，并分发给 EMS 社区。在使用有针对性的教学材料对 EMS 专业人员进行教育后，将在当地 EMS 系统中实施这些协议。最后，将通过综合质量改进和结果监测系统来衡量效果和采用率。参与模型开发过程的利益相关者和专家得出结论，使用这种透明、客观和科学严谨的指南可以显著提高未来 EMS 护理的质量。
