Evidence Based Medicine in EMS


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Education forum presentation on Evidence Based Medicine / Evidence Based Practice.

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Evidence Based Medicine in EMS

  1. 1. What is Evidence Based Medicine?
  2. 2. Where do I find the evidence?
  3. 3. Questions to ask • Can I trust this information? • If the information is true, will the use of this information make an important difference? • Can I use the information in this instance?
  4. 4. Why should I care? •Potential to change what you do •Potential to change how you do it •Ultimately, can help you to deliver better care to your patients
  5. 5. CPR & ECC Guidelines
  6. 6. CPR - 1916
  7. 7. What about? • Back Blows • Chest Thrusts • Cricothyrotomy • Direct Laryngoscopy • Heimlich Maneuver • Oxygen
  8. 8. What about?
  9. 9. What about?
  10. 10. Evaluating Evidence Quality • Sample size • Single centre v Multi centre • Blinded • Randomised • Controlled • Study subjects
  11. 11. Sample Size • The more patients we examine, the more certain we can be of our results
  12. 12. Multi-centre • Multiple teams from multiple institutions each duplicating the same study procedure • Reduces the chances that a systematic error by any one team will skew the study’s results
  13. 13. Double-blind
  14. 14. Randomised
  15. 15. Study Subjects
  16. 16. Evaluating Evidence Quality The gold standard of all scientific studies in EMS and medicine are large, multi-centre, double-blind, randomized controlled trials performed on human subjects.
  17. 17. • Three tourists are riding together on a train in Scotland. They look out the window, and see a black sheep. One tourist says, “Fascinating! All Scottish sheep are black!”
  18. 18. • The second tourist says, “No, no, no! Only some Scottish sheep are black.”
  19. 19. • The third tourist rolls his eyes at his two companions and says, “Gentlemen, all we can say for sure is that there is one sheep in Scotland that appeared to be black on one side to the three of us while this train car was passing by it.”
  20. 20. Not all evidence is as it seems
  21. 21. More reading • http://prehospitalresearch.eu/?p=772 • http://prehospitalresearch.eu/?p=1176 • Sackett DL, Rosenberg WM, Gray JA, Haynes RB, Richardson WS. Evidence based medicine: what it is and what it isn’t. BMJ. 1996 Jan 13;312(7023):71-2. PMID: 8555924. • Hess DR. What is evidence-based medicine and why should I care? Respir Care. 2004 Jul;49(7):730-41. PMID: 15222906.