"We know this works, but where is the standard that tells us?" asked Corey Slovis, MD, medical director of Nashville Fire Department. Slovis' call for standardization and justification was echoed in many other sessions last week at the annual meeting of the National Association of EMS Physicians (NAEMSP). Hundreds of EMS physicians from across the country and the world convened in Phoenix, Ariz., to share their experiences, lessons and goals, planting seeds of change in their peers.
In Slovis' session on evidence-based performance, he opened by joking that Nashville was the best EMS system in the country. His logic was that because we have no agreed upon measurements, any EMS system can choose the most obscure parameters -- the rate of successful cardiac arrest resuscitations on Tuesdays by providers named Fred -- means that anyone can be the best in some respect. (However, he did disclose that Nashville's E2B time is 74 minutes, well below the recommended 90.)
He urged NAEMSP to establish standards, such as which patients do not need to be resuscitated, arguing that if NAEMSP decided this as a group, it would relieve some individual liability. "That's the power of being a group."
Slovis took a stand on a few interventions, as well. He stated that 12-lead ECGs and CPAP need to be universal in the field because the literature supporting the use of these devices cannot be ignored.
Always one to use humor to make his point, he closed with another joke, quoting Nietzsche, "Out of chaos, comes order." But he added, "For those that think I'm bragging, I learned that from 'Blazing Saddles.'"
Sharing the session time with Slovis was Andrew Travers, MD, who talked about other areas of evidence. In addition to evidence published in peer-reviewed journals, he reminded us to value operational and cultural evidence, such as dashboard data on ED turnaround times and national reports on the state of health care. He also encouraged everyone to read the2008 Myers et al paper on evidence-based performance measurements.
Another notable lecture was delivered by thought-leader Mickey Eisenberg, MD. He presented sobering statistics about the disparity among out-of-hospital cardiac arrest (OOHCA) survival rates. Specifically, he noted that Detroit's save rate is 0%, and offered specific steps any EMS system can take to improve their outcomes.(For more, read "Why Didn't My Patient Survive?")
Another interesting session discussed the importance of preserving the collegial relationship with law enforcement while understanding what patient information is and isn't permissible to release. One controversial point that Michael Frank, MD, JD, made was advising cities to consider cross-training police to draw blood.(For more, read "We're Not Phlebotomists, But Police Are!")
Frank also described a case of in which EMS was surprisingly found guilty of willful and wanton misconduct.(Watch the video here.)
Among the mix of clinical and ethical discussions, Greg Mears, MD, presented what the upcoming release of NEMSIS Version 3 will mean for EMS systems. Mears emphasized that the changes will focus on collecting more meaningful, complete, valid, useful and timely data for an improved user experience.(For more, read "No More Gold or Silver Data.")
Other powerful sessions included those presented by Drs. Lars Wik and Harry Selker on the status and lessons from the CIRC and IMMEDIATE trials, Drs. Jim Dunford from San Diego and David Persse from Houston on their programs to address frequent users, and Drs. David Cone John McManus on their top 10 research articles from 2009.
Watch JEMS.com for more reports from this important conference.