National Prehospital Evidence-Based Guidelines Strategy: A Summary for EMS Stakeholders

Multiple national organizations have recommended and supported a national investment to increase the scientific evidence available to guide patient care delivered by Emergency Medical Services (EMS) and incorporate that evidence directly into EMS systems. Ongoing efforts seek to develop, implement, and evaluate prehospital evidence-based guidelines (EBGs) using the National Model Process created by a multidisciplinary panel of experts convened by the Federal Interagency Committee on EMS (FICEMS) and the National EMS Advisory Council (NEMSAC). Yet, these and other EBG efforts have occurred in relative isolation, with limited direct collaboration between national projects, and have experienced challenges in implementation of individual guidelines. There is a need to develop sustainable relationships among stakeholders that facilitate a common vision that facilitates EBG efforts. Herein, we summarize a National Strategy on EBGs developed by the National Association of EMS Physicians (NAEMSP) with involvement of 57 stakeholder organizations, and with the financial support of the National Highway Traffic Safety Administration (NHTSA) and the EMS for Children program. The Strategy proposes seven action items that support collaborative efforts in advancing prehospital EBGs. The first proposed action is creation of a Prehospital Guidelines Consortium (PGC) representing national medical and EMS organizations that have an interest in prehospital EBGs and their benefits to patient outcomes. Other action items include promoting research that supports creation and evaluates the impact of EBGs, promoting the development of new EBGs through improved stakeholder collaboration, and improving education on evidence-based medicine for all prehospital providers. The Strategy intends to facilitate implementation of EBGs by improving guideline dissemination and incorporation into protocols, and seeks to establish standardized evaluation methods for prehospital EBGs. Finally, the Strategy proposes that key stakeholder organizations financially support the Prehospital Guidelines Consortium as a means of implementing the Strategy, while together promoting additional funding for continued EBG efforts.

多国国家级组织已倡议并支持一项国家级投入，旨在增加可用于指导急诊医疗服务（Emergency Medical Services, EMS）开展临床诊疗的科学证据，并将此类证据直接整合至EMS体系当中。当前相关工作正依托由联邦跨部门急诊医疗服务委员会（Federal Interagency Committee on EMS, FICEMS）与国家急诊医疗服务咨询委员会（National EMS Advisory Council, NEMSAC）联合召集的多学科专家小组制定的国家标准化流程，推进院前循证指南（Evidence-Based Guidelines, EBGs）的开发、实施与评估工作。然而，此类及其他循证指南相关项目多处于相对孤立的状态，国家级项目间直接协作有限，且单个指南的落地实施均面临诸多挑战。亟需在各利益相关方之间建立可持续的协作关系，以形成共同愿景，推动循证指南相关工作的开展。本文综述了由国家急诊医疗服务医师协会（National Association of EMS Physicians, NAEMSP）牵头，联合57家利益相关方组织，并获得国家公路交通安全管理局（National Highway Traffic Safety Administration, NHTSA）与儿童急诊医疗服务项目经费支持所制定的《院前循证指南国家战略》。该战略提出七项行动举措，以推进院前循证指南的协同开发与落地工作：第一项行动为组建院前指南联盟（Prehospital Guidelines Consortium, PGC），汇聚所有关注院前循证指南及其对患者结局改善作用的国家级医学与急诊医疗服务组织；其余行动举措包括：推动支持循证指南制定与效果评估的相关研究，通过强化利益相关方协作促进新指南的开发，为全体院前急救从业人员提供循证医学相关教育培训。该战略旨在通过优化指南传播与临床方案整合流程，推动循证指南的落地实施，并致力于建立院前循证指南的标准化评估方法。最后，该战略提议由核心利益相关方组织为院前指南联盟提供经费支持，作为战略落地的实施路径，同时共同呼吁为持续开展的循证指南相关工作争取更多专项资金。