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The Canadian prehospital evidence-based protocols project: knowledge translation in emergency medical services care.

https://arctichealth.org/en/permalink/ahliterature149040
Source
Acad Emerg Med. 2009 Jul;16(7):668-73
Publication Type
Article
Date
Jul-2009
Author
Jan L Jensen
David A Petrie
Andrew H Travers
Author Affiliation
Division of Emergency Medical Services, Dalhousie University, Emergency Health Services, Halifax, Nova Scotia, Canada. jljensen@dal.ca
Source
Acad Emerg Med. 2009 Jul;16(7):668-73
Date
Jul-2009
Language
English
Publication Type
Article
Keywords
Canada
Diffusion of Innovation
Emergency Medical Services - standards - trends
Evidence-Based Medicine
Health Knowledge, Attitudes, Practice
Humans
Information Dissemination
Nova Scotia
Organizational Innovation
Organizational Objectives
Abstract
The principles of evidence-based medicine are applicable to all areas and professionals in health care. The care provided by paramedics in the prehospital setting is no exception. The Prehospital Evidence-based Protocols Project Online (PEP) is a repository of appraised research evidence that is applicable to interventions performed in the prehospital setting and is openly available online. This article describes the history, current status, and potential future of the project.
The primary objective of the PEP is to catalog and grade emergency medical services (EMS) studies with a level of evidence (LOE). Subsequently, each prehospital intervention is assigned a class of recommendation (COR) based on all the appraised articles on that intervention, in an effort to organize the evidence so it may be put into practice efficiently. An LOE is assigned to each article by the section editor, based on the study rigor and applicability to EMS. The section editor committee consists of EMS physicians and paramedics from across Canada, and two from Ireland and a paramedic coordinator. The evidence evaluation cycle is continuous; as the section editors send back appraisals, the coordinator updates the database and sends out another article for review.
The database currently has 182 individual interventions organized under 103 protocols, with 933 citations.
This project directly meets recent recommendations to improve EMS by using evidence to support interventions and incorporating it into protocols. Organizing and grading the evidence allows medical directors and paramedics to incorporate research findings into their daily practice. As such, this project demonstrates how knowledge translation can be conducted in EMS.
PubMed ID
19691810 View in PubMed
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Comparison of tracheal intubation and alternative airway techniques performed in the prehospital setting by paramedics: a systematic review.

https://arctichealth.org/en/permalink/ahliterature144948
Source
CJEM. 2010 Mar;12(2):135-40
Publication Type
Article
Date
Mar-2010
Author
Jan L Jensen
Ka Wai Cheung
John M Tallon
Andrew H Travers
Author Affiliation
Division of Emergency Medical Services, Dalhousie University, Dartmouth, Nova Scotia. jljensen@dal.ca
Source
CJEM. 2010 Mar;12(2):135-40
Date
Mar-2010
Language
English
Publication Type
Article
Keywords
Allied Health Personnel
Emergency Medical Services - methods - standards
Humans
Intubation, Intratracheal - standards
Ontario
Professional Competence
Respiration, Artificial - methods - standards
Respiratory Insufficiency - therapy
Abstract
This systematic review included controlled clinical trials comparing tracheal intubation (TI) with alternative airway techniques (AAT) (bag mask ventilation and use of extraglottic devices) performed by paramedics in the prehospital setting. A priori outcomes to be assessed were survival, neurologic outcome, airway management success rates and complications. We identified trials using EMBASE, MEDLINE, CINAHL, The Cochrane Library, Web of Science, author contacts and hand searching. We included 5 trials enrolling a total of 1559 patients. No individual study showed any statistical difference in outcomes between the TI and AAT groups. Because of study heterogeneity, we did not pool the data. This is the most comprehensive review to date on paramedic trials. Owing to the heterogeneity of prehospital systems, administrators of each system must individually consider their airway management protocols.
PubMed ID
20219161 View in PubMed
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Consensus on paramedic clinical decisions during high-acuity emergency calls: results of a Canadian Delphi study.

https://arctichealth.org/en/permalink/ahliterature130920
Source
CJEM. 2011 Sep;13(5):310-8
Publication Type
Article
Date
Sep-2011
Author
Jan L Jensen
Pat Croskerry
Andrew H Travers
Author Affiliation
Division of Emergency Medical Services, Dalhousie University, Halifax, NS, Canada. jljensen@dal.ca
Source
CJEM. 2011 Sep;13(5):310-8
Date
Sep-2011
Language
English
Publication Type
Article
Keywords
Adult
Canada
Decision Making
Delphi Technique
Emergency Medical Services - statistics & numerical data
Emergency Medical Technicians
Humans
Abstract
To establish consensus on the most important clinical decisions paramedics make during high-acuity emergency calls and to visualize these decisions on a process map of an emergency call. A secondary objective was to measure agreement among paramedics and medical director panel members.
A multiround online survey of Canadian paramedics and medical directors. In round 1, participants listed important clinical decisions. In round 2, participants scored each decision in terms of its importance for patient outcome and safety. In rounds 3 and 4, participants could revise their scores. Consensus was defined a priori: 80% or more agreement that a decision was important or extremely important. The included decisions were plotted on a process map of a typical emergency call.
The panel response rates were as follows: round 1, 96%; round 2, 92%; round 3, 83%; and round 4, 96%. Consensus was reached on 42 decisions, grouped into six categories: airway management (n ?=? 13); assessment (n ?=? 3); cardiac management (n ?=? 7); drug administration (n ?=? 9); scene management (n ?=? 4); and general treatment (n ?=? 6). The on-scene treatment phase of the process map was found to have the highest decision density. Paramedics and medical directors differed in their scoring in 5 of 42 decisions (p
PubMed ID
21955412 View in PubMed
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The development of a national emergency medical services curriculum framework for physicians in Canada.

https://arctichealth.org/en/permalink/ahliterature156453
Source
Prehosp Emerg Care. 2008 Jul-Sep;12(3):372-80
Publication Type
Article
Author
Russell D MacDonald
Joseph Ip
Karen Wanger
Adrienne Rothney
Kirstie McLelland
Andrew H Travers
P Richard Verbeek
Sunil Sookram
Erik Vu
Ed Cain
Michael Feldman
Brian Schwartz
Author Affiliation
Ornge Transport Medicine, Toronto, Ontario, Canada. rmacdonald@ornge.ca
Source
Prehosp Emerg Care. 2008 Jul-Sep;12(3):372-80
Language
English
Publication Type
Article
Keywords
Canada
Competency-Based Education
Curriculum
Emergency Medical Services - manpower
Emergency Medicine - education
Family Practice - education
Fellowships and Scholarships
Guidelines as Topic
Humans
Internship and Residency
Abstract
As the role of emergency medical services (EMS) continues to expand, EMS physicians and medical directors require special skills and training to keep pace with the rapidly evolving subspecialty of EMS. In Canada, subspecialty training in EMS is still relatively new, and a standard national curriculum for physician EMS training does not exist.
To develop a national EMS curriculum for emergency medicine (EM) residents and fellows and an abbreviated curriculum for non-EM trainees and community physicians.
The authors obtained EMS curricula and opportunities from Canadian EM and EMS training programs and a sample of U.S. programs to determine existing curricula, and developed a framework for a national EMS curriculum using an expert working group of EMS medical directors and EMS leaders in Canada.
Canadian EM residency training programs included an EMS rotation, but their content and depth of training were not uniform. The expert working group proposed a comprehensive set of training objectives, grouped into 16 categories, stratified by level of training.
The proposed framework and objectives are suitable for training medical students, family medicine trainees, community physicians, EM residents, and EMS fellows in Canada. The authors hope this article will serve as a guideline for residency and fellowship directors to develop their EMS training programs in a consistent manner, promote formal training for physicians involved in EMS, and help define the specific knowledge and expertise required of physicians who provide EMS medical direction in Canada.
PubMed ID
18584507 View in PubMed
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Methodology for the development of a Canadian national EMS research agenda.

https://arctichealth.org/en/permalink/ahliterature130836
Source
BMC Emerg Med. 2011;11:15
Publication Type
Article
Date
2011
Author
Jan L Jensen
Ian E Blanchard
Blair L Bigham
Katie N Dainty
Doug Socha
Alix Carter
Lawrence H Brown
Alan M Craig
Andrew H Travers
Ryan Brown
Ed Cain
Laurie J Morrison
Author Affiliation
Emergency Health Services, 239 Brownlow Avenue, Dartmouth, Nova Scotia, Canada. jljensen@dal.ca
Source
BMC Emerg Med. 2011;11:15
Date
2011
Language
English
Publication Type
Article
Keywords
Canada
Consensus Development Conferences as Topic
Delphi Technique
Emergency medical services
Evidence-Based Emergency Medicine
Health Policy
Health Services Research
Humans
Information Dissemination
Interviews as Topic
Abstract
Many health care disciplines use evidence-based decision making to improve patient care and system performance. While the amount and quality of emergency medical services (EMS) research in Canada has increased over the past two decades, there has not been a unified national plan to enable research, ensure efficient use of research resources, guide funding decisions and build capacity in EMS research. Other countries have used research agendas to identify barriers and opportunities in EMS research and define national research priorities. The objective of this project is to develop a national EMS research agenda for Canada that will: 1) explore what barriers to EMS research currently exist, 2) identify current strengths and opportunities that may be of benefit to advancing EMS research, 3) make recommendations to overcome barriers and capitalize on opportunities, and 4) identify national EMS research priorities.
Paramedics, educators, EMS managers, medical directors, researchers and other key stakeholders from across Canada will be purposefully recruited to participate in this mixed methods study, which consists of three phases: 1) qualitative interviews with a selection of the study participants, who will be asked about their experience and opinions about the four study objectives, 2) a facilitated roundtable discussion, in which all participants will explore and discuss the study objectives, and 3) an online Delphi consensus survey, in which all participants will be asked to score the importance of each topic discovered during the interviews and roundtable as they relate to the study objectives. Results will be analyzed to determine the level of consensus achieved for each topic.
A mixed methods approach will be used to address the four study objectives. We anticipate that the keys to success will be: 1) ensuring a representative sample of EMS stakeholders, 2) fostering an open and collaborative roundtable discussion, and 3) adhering to a predefined approach to measure consensus on each topic. Steps have been taken in the methodology to address each of these a priori concerns.
Notes
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PubMed ID
21961624 View in PubMed
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Paramedic clinical decision making during high acuity emergency calls: design and methodology of a Delphi study.

https://arctichealth.org/en/permalink/ahliterature148399
Source
BMC Emerg Med. 2009;9:17
Publication Type
Article
Date
2009
Author
Jan L Jensen
Pat Croskerry
Andrew H Travers
Author Affiliation
Division of Emergency Medical Services, Department of Emergency Medicine, Dalhousie University, 1796 Summer Street, Room 3021, Halifax, Nova Scotia, Canada. jljensen@dal.ca
Source
BMC Emerg Med. 2009;9:17
Date
2009
Language
English
Publication Type
Article
Keywords
Canada
Cross-Sectional Studies
Decision Making
Delphi Technique
Emergency medical services
Emergency Medical Technicians - psychology
Health Care Surveys
Humans
Abstract
The scope of practice of paramedics in Canada has steadily evolved to include increasingly complex interventions in the prehospital setting, which likely have repercussions on clinical outcome and patient safety. Clinical decision making has been evaluated in several health professions, but there is a paucity of work in this area on paramedics. This study will utilize the Delphi technique to establish consensus on the most important instances of paramedic clinical decision making during high acuity emergency calls, as they relate to clinical outcome and patient safety.
Participants in this multi-round survey study will be paramedic leaders and emergency medical services medical directors/physicians from across Canada. In the first round, participants will identify instances of clinical decision making they feel are important for patient outcome and safety. On the second round, the panel will rank each instance of clinical decision making in terms of its importance. On the third and potentially fourth round, participants will have the opportunity to revise the ranking they assigned to each instance of clinical decision making. Consensus will be considered achieved for the most important instances if 80% of the panel ranks it as important or extremely important. The most important instances of clinical decision making will be plotted on a process analysis map.
The process analysis map that results from this Delphi study will enable the gaps in research, knowledge and practice to be identified.
Notes
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Cites: J Clin Nurs. 2003 Jul;12(4):476-8312790860
Cites: Acad Emerg Med. 2004 Feb;11(2):196-914759966
Cites: Am J Public Health. 1984 Sep;74(9):979-836380323
Cites: J Adv Nurs. 1987 Nov;12(6):729-343320139
Cites: Int J Nurs Stud. 1993 Jun;30(3):227-378335432
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Cites: Prehosp Emerg Care. 2007 Apr-Jun;11(2):234-917454815
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Cites: Nurse Educ Pract. 2008 May;8(3):177-8317869587
Cites: Am J Emerg Med. 1999 Oct;17(6):544-710530531
PubMed ID
19772558 View in PubMed
Less detail

6 records – page 1 of 1.