-
Developing effective clinical practice guidelines for ambulance services.
by Marc Colbeck. Last modified: 04/04/15
Brown, G. (2000). Developing effective clinical practice guidelines for ambulance services. Pre-Hospital Immediate Care, 4, 136–140. (not available online)
This is obviously an older article but it’s a great overview of some of the issues surrounding developing guidelines for paramedics. The author points out that there (was) some fairly extreme variation in clinical practice by UK medics (e.g. the maximum dose of naloxone varied between 800 and 10,000 mcg!).
The focus of the article are four main issues that the author goes on to examine in separate sections.
- The credibility and validity of the guidelines:
- drawing from existing guidelines increases credibility and decreases work
- soliciting buy-in from opinion leaders is important
- proving health gains supports credibility
- User acceptance of guidelines:
- parochialism and resistance to curbing autonomy and flexibility are common concerns in regards to guidelines that need to be addressed, including end-users and explicitly addressing their concerns is important.
- The amount of change in clinical practice they produce:
- Guidelines may be ignored by managers if they are predicted to require additional costs, equipment or training resources.
- The author makes an important point about what sort of immunity guidelines may grant. Noting:Presently, however, it is unclear whether adherence to guidelines confers immunity from liability or if non-adherence increases the likelihood of being found negligent if a patient suffers harm as a result because, in English law, guidelines carry little weight. They are considered ‘hearsay’ evidence because, unlike an expert witness, they cannot be examined and cross examined. However, it is worth noting that in the United States, legally validated guidelines have been used as a complete defence in a malpractice claim”.
I’ve contacted Michael Eburn from the Australian Emergency Law blog to ask him his impression of the Australian context in regards to the above.
- The author quotes another study which lists 3 essential components which result in improved acceptance of guidelines:
- explicit identification of the major decisions relevant to patients
- collation of valid evidence
- concise presentation of the evidence (ensuring that they are easy to use)
- He also quotes a different author who describes three components which encourage uptake:
- a simple algorithm of steps to follow
- an explanation of the content of the algorithm
- a detailed summary of the underpinning evidence
- The health gain that those changes produce:
- The author suggests that comparison with national benchmarks is of higher quality than retrospective evaluation of outcomes before introduction of the new CPGs, although this is obviously more complex and requires greater cooperation with external agencies (to determine eventual outcome).
- The author also suggests that all paramedic paperwork have a section dedicated for possible explanations of why care deviated from the CPGs.
The final section of the paper points out the amount of expertise that is required to translate research into clinical practice (something I’m getting an appreciation of!) and the tremendous amount of time and resources it requires, and suggests that these requirements are far beyond the resources of ambulance services.
For comparisons sake, I know in South Australia they did a trial project of producing one robustly evidence-based CPG (it was really good) and it took approximately 250 staff hours. Australasian ambulance services have about 100 CPGs (on average) which means that it would take about 25,000 hours to write a comprehensive, complete set of highly researched CPGs. Multiply that by whatever you pay your paramedics on overtime (let’s just say $50 an hour), and that’s a budget of at least $1.25 million – not including any support staff work or hiring a PhD to oversee the project. I can tell you, none of the CAA members have the resources to do that.
Writing appropriate, best-practice CPGs will necessarily have to be a voluntary collaborative effort of many people.
The following two tabs change content below.Marc Colbeck
Senior Lecturer at Australian Catholic UniversityMarc is a Canadian Critical Care Paramedic with 14 years of clinical experience who has been working as a professional educator since the early 2000's. He has taught at the College and University level in the Middle East and Australia, and worked as the General Manager of Clinical Governance for an Australian State Ambulance Service. He is currently a Senior Lecturer at Australian Catholic University in Queensland, Australia. His undergraduate degree is in PreHospital Care and his MA is in Counseling Psychology. He is currently working on a PhD in Translational Health Sciences with the Joanna Briggs Institute at the University of Adelaide, with a special interest in the development and maintenance of paramedic CPGs. His website is www.marccolbeck.info.Latest posts by Marc Colbeck (see all)
- Developing effective clinical practice guidelines for ambulance services. - 04/04/15
- Adherence to guidelines and protocols in the prehospital and emergency care setting: a systematic review. - 07/03/15
- Knowledge translation in emergency medical services: A qualitative survey of barriers to guideline implementation. - 26/02/15
- Adherence to resuscitation guidelines during prehospital care of cardiac arrest patients - 14/01/15
- Adherence to guidelines and protocols in the prehospital and emergency care setting: a systematic review - 05/01/15
- The credibility and validity of the guidelines:
Developing effective clinical practice guidelines for ambulance services.
Get weekly email updates!
Cast Your Vote

Categories
- Blogs (40)
- Case Studies (8)
- Featured Article (23)
- How-To (47)
- FOAM (8)
- News (117)
- Conference Tweets (31)
- Pharmacology (1)
- Adrenaline (1)
- Research (180)
- Advanced Practice (2)
- Airway Management (6)
- Anaphylaxis (2)
- Cardiac (15)
- Community Paramedic (2)
- Critical Care Paramedic (4)
- Diagnostics (3)
- Dispatch (1)
- ECG (4)
- Education (10)
- EMS Operations (2)
- End-of-Life Care (3)
- Geriatrics (9)
- Guidelines (22)
- HEMS (4)
- Mass Casualty (2)
- Medical Conditions (5)
- Mental Health (7)
- Military & Tactical (2)
- Neonatal (1)
- Neuro (11)
- Obstetrics (1)
- Paediatrics (4)
- Pain Management (4)
- Poster Presentations (5)
- Professionalism (5)
- Remote, Industrial & Austere (6)
- Respiratory (5)
- Resuscitation (27)
- Rural (3)
- Safety (3)
- Sepsis (7)
- Shock (2)
- Simulation (7)
- Sports Medicine (1)
- Trauma (20)
- Reviews (6)
- Conferences (5)
- Courses (1)
Upcoming Events
There are no upcoming events at this time.
News
- Free access: Resuscitation Today Vol 3 Issue 2 (27/06/16)
- Free CPD at the Emergency Services Show (23/05/16)
- Canadian Paramedicine Feb/Mar 2016 – Open Access Issue (11/04/16)
- Free access: Resuscitation Today Volume 3 Issue 1 (01/04/16)
- Introducing the Irish Journal of Paramedicine (22/11/15)
Latest How-To Articles
- Paramedic students…write something! (28/04/16)
- Understanding diagnostic tests 2: likelihood ratios, pre- and post-test probabilities and their use in clinical practice (30/01/15)
- Understanding diagnostic tests 1: sensitivity, specificity and predictive values (11/12/14)
- GRADE guidelines – best practices using the GRADE framework (22/11/14)
- How to get started with EMS research – JEMS (16/05/14)
Recent Comments
- Jin Sook Hyun on Case Study #2: Anaphylaxis
- Joe on Case Study #1: Heroin overdose
- Stef on C.R.A.S.H.E.D – A model for structured reflection in prehospital care.
- G. Yabut, RN on Rapid Reviews: Vital signs in CVAs – which arm?
ReSEARCH
Tags
academic ACS AED airway management ambulance AMI Australia Canada cardiac cardiac arrest case study CCP clinical management computer conference consensus CPG CPR CPR UL critical care CVA database ECG education elderly EMS evidence based FOAM FPHC geriatric guide guideline guidelines haemorrhage HEMS immobilisation Ireland journal medication mental health neurology news OHCA online paediatric pain management paramedic prehospital PTSD reference research resuscitation review safety sepsis simulation social media software spinal STEMI stress stroke study TBI training Translational Health Sciences trauma Twitter UK USA
Archives