P056: The state of the evidence for emergency medical services (EMS) care of blunt spinal trauma: an analysis of appraised research from the Canadian Prehospital Evidence-based Practice (PEP) Project

Abstract

Introduction:Patients who require end of life (EoL)/palliative care occasionally need assistance from paramedics. This review evaluated the evidence for paramedic-delivered EoL/palliative care interventions. Methods: The Canadian Prehospital Evidence-based Practice (PEP) Project methodology was used. A PubMed search was conducted, using Medical Subject headings and title/abstract key words. Titles and abstracts were reviewed for relevance. Studies were not required to be EMS based but must have focused on interventions available to EMS personnel. Included full text studies were scored by trained primary appraisers on a three-point Level of Evidence (LOE) scale (high = 1, moderate = 2 and low = 3) and three-point Direction of Evidence (DOE) scale (supportive, neutral, or opposing). Studies were categorized by clinical condition (n = 5) and by intervention (n = 25), and plotted on 3×3 (DOE × LOE) tables. The study primary outcome and setting were determined. Results: The search returned 3255 articles; 86 were selected for abstract review; with 30 full text articles ultimately included. Intervention recommendations were: LOE 1-supportive (n = 3, 12%), 2-supportive (n = 2, 8%), 3-supportive (n = 2, 8%), 1-neutral (n = 2, 8%), 2-neutral (n = 2, 8%), 3-neutral (n = 4, 16%). No primary studies were identified for 10 (40%) interventions. Conditions with 1-supportive studies were: 'breathlessness' and 'analgesia'. 'Secretions' condition had no relevant evidence. Interventions with 1-supportive evidence were: Haldol for agitation (n = 1), fentanyl and morphine for analgesia (n = 3 and n = 1), narcotics for breathlessness (n = 1). No intervention had opposing evidence. Primary outcomes were more commonly related to symptom relief (n = 26, 87%), safety (n = 3, 10%), or tolerability (n = 1, 3%). Only one included study was conducted in the EMS setting. Conclusion: Evidence for interventions used by paramedics in the treatment of patients requiring EoL/palliative care was identified, as were evidence gaps. Little research was conducted in the EMS setting, and most interventions had few studies. These PEP findings highlight topics requiring high quality EMS research specific to EoL/palliative care to inform this growing aspect of paramedic practice. Keywords: palliative care, emergency medical services (EMS), end-of-life care P056The state of the evidence for emergency medical services (EMS) care of blunt spinal trauma: an analysis of appraised research from the Canadian Prehospital Evidence-based Practice (PEP) Project A. Carter, MD, J. Greene, BSc, J. Cook, MD, J. Goldstein, PhD, J. Jensen, MSc; Dalhousie University, Halifax, NS Introduction: The Canadian Prehospital Evidence-based Practice (PEP) project is an online, freely accessible, continuously updated EMS evidence repository. The summary of research evidence for EMS interventions used to care for blunt spinal trauma is described. Methods: PubMed was systematically searched. One author reviewed titles and abstracts for relevance. Included studies were scored by trained ...

State of the Evidence for Emergency Medical Services (EMS) Care: The Evolution and Current Methodology of the Prehospital Evidence-Based Practice (PEP) Program

“…All clinicians should be able to use PEP regardless of their EBM experience. The PEP program has been presented at several national (CAEP) ( Carter et al 2016 ) and international conferences ( Carter et al 2015 ). More recently, PEP was presented as a plenary at the National Association of EMS Physicians annual meeting in January 2018 and PEP continues to have a standing update during the conference.…”