Marius Rehn examines the difficulties and importance of evidence based medicine in prehospital resuscitation. Notably, combining academic activity with pre- and in-hospital clinical practice is hard work. Being an academic in a flight suit can be quite lonely. Marius wants this to change and is passionate about increasing the quantity and quality of prehospital research. Prehospital research that examines patient pathophysiology should dictate care – as it does in the hospital environment. However, Evidence based practice pertaining to the prehospital environment is minimal. This needs to change. Evidence based medicine in the prehospital setting can dictate care, critically appraise practice and enable improvements in process and cost effectiveness whilst decreasing harms. Evidently, in-hospital evidence is different to the field application. Ultimately, prehospital research is critical, 5.8 million people die from injury every year – around 10% of the world’s deaths. Unfortunately, pre-hospital research is underfunded. So, how can we take interventions from the hospital to the streets? Marius shares three important steps: The research that is needed How to interpret the evidence Why all research is important to consider (from case studies to randomised controlled trials) Moreover, Marius highlights the need to lean on other members of the scientific community when conducting your own research. For example, a statistician is worth their weight in gold in observational studies when fleshing out regression analysis. Finally, Marius discusses the importance of information dissemination across all platforms, including peer reviewed journals and informal FOAMed platforms such as Twitter. They all have their place. For more like this, head to our podcast page. #CodaPodcast

1. SMACC Dublin
Marius Rehn
@DrRehn
Norwegian Air Ambulance Foundation
London´s Air Ambulance
University of Stavanger
How to do pre-hospital research

2. Painfully complicated; Publications
Practical work; Lonely
Hard work: Clinical-Academical

3. Patient pathophysiology-strategies of care
Care: Influence outcome the most
Evidence-based: PH-practice
Critically appraising our practice:
Improvement/harm/cost-effectiveness

4. Cannot extrapolate in-hospital evidence-field
Pre-hospital environment:
Kit, diagnostic, crew

5. 0
1
2
3
4
5
6
7 Deaths per year
(millions)
Injury HIV/AIDS, TB and Malaria
Injuries and violence:The facts.WHO; 2010
10% deaths
PH-research is underfunded
Quality of evidence is weak
How can you contribute?
Components
5.8

6. Transfusion
paperwork
Golden hour box™
4 emergency units of
O Rh negative packed
red blood cells
Sealed by
blood bank
Maintain steady state temperature
of 2-4C for 48-72 hours
Data logger
15450
10
20
30
40
50
60
Unit of packed
red blood cells
Battery pack
Blood warmer
giving set
Blood giving set
3-way tap and 50 ml syringe
for intraosseous administration
Patient
Blood warmer
heating element
Blood giving set
Relevant - patient oriented questions
“So what” filter

7. Hospital - Street
Test: Feasibility and impact on outcome

8. PH: injuries evolving, classic features;
“fully established disease”
Indications/contraindications
Diagnostic test accuracy

9. Before embark: Recent and seminal pieces
Systemic review: identification, data extraction,
quality appraisal, meta-analysis

10. Crux: Study methodology
Hierarchy of evidence: Expert opinion-RCT
Aim high: not dismiss Case series: High volume
Observational studies: Causation / Association

11. RCT: Systematic skewness
Not impossible
Solid framework: Funding, data collection,
experienced researcher, commitment
PH-cancer care: Systematic hard work
Increase level of evidence

12. Statistical models
Observational: Regression
Not feasible: Mathematicians
Statisticians
Selective publication: positive studies
Negative studies

13. Science lead to change: Communicated
SMACC: FOAM vs conservative scientific establishment
Editorial peer review + Unmoderated debate
Merge science with education; Twitter

14. Clinician, relevant hypotheses, designer of research methods,
analyser of data, interpreter of results, current literature, decent
writer - communicator of science, 140 characters
Fascinating, vital, never completely mastered

15. Evidence-based medicine
Preserve limited resources
Seek evidence it is lacking
Dichotomy Know and Do
Quest: Critical care without walls