evidence based medicine in ems

What is Evidence Based Medicine?

Where do I find the evidence?

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?

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

CPR & ECC Guidelines

CPR - 1916

What about?• Back Blows• Chest Thrusts• Cricothyrotomy• Direct Laryngoscopy• Heimlich Maneuver• Oxygen

What about?

What about?

Evaluating Evidence Quality• Sample size• Single centre v Multi centre• Blinded• Randomised• Controlled• Study subjects

Sample Size• The more patients we examine, the more certain

we can be of our results

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

Double-blind

Randomised

Study Subjects

Evaluating Evidence QualityThe gold standard of all scientific studies in EMS and

medicine are large, multi-centre, double-blind, randomized controlled trials performed on human

subjects.

• 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!”

• The second tourist says, “No, no, no! Only some Scottish sheep are black.”

• 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.”

Not all evidence is as it seems

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.