EBM, Tools, and Their Applicability to Paramedics
The Journal of Emergency Medical Services (JEMS) published an article about the paramedic from its birth through today (Edgerly, 2013). It is an interesting article that if you have not yet to read, I firmly suggest taking a quick look, that said, it is not necessary to realize progress has been made, and there are many come. The primary concern for us as paramedics is the implementation of evidence-based medicine (EBM). I am not suggesting we do not practice the researched evidence. What I worry about, is how that looks from a provider standpoint.
My concern is how this affects our care on the streets, it seems like the evidence comes out and yet we are some of the last providers to put this research into practice but more critically, is it necessary in our environment, is it practical? For example, the use of point of care of ultrasound (POCUS). This is a fantastic tool that, by all means, is used for a range of interventions. But frankly, does that impact us on five-minute transport times, or does it delay care when we know a patient likely has an internal bleed based on their mechanism of injury? If we find a bleed with this compact and useful tool, does it change what we providers on the street are going to do for our patients? Is the hospital going to redo the ultrasound (US) and delay intervention or trust our findings? I do not know the answer.
What I know is that education is a massive component of this, and paramedics should be provided an all-encompassing curriculum that incorporates many of these diagnostic tools. This is important because, just because your school is located in a state that does not use POCUS, you might move to one that does. Moreover, are agencies training on this sort of diagnostic check routinely enough so that providers are familiar with what they should be looking for, or does that even matter?
Here is a thought on the advantage and disadvantages of POCUS that you might find intriguing, and please understand that this is my bias perspective but is supported through research. One study showed that POCUS increased the pulse check from 13 seconds to 21 seconds – much longer than 10 seconds, as to suggest by our good friends at the American Heart Association. Conversely, the same study showed improved survivability when POCUS was used during cardiac arrest to look for return for spontaneous circulation (Smallwood & Daschel, 2018). In this same article, training is one of the most considerable barriers, so again, we are back at square one; are educators available to provide training to clinicians in a way that assures each provider is proficient.
Am I a proponent of change, yes, but is it practical for us in the actual prehospital environment without advanced practitioners around to guide us through the process? What are your thoughts, and please hurt my feelings? I prefer a little debate here and there – so please pummel me with your ideas, I look forward to it.
Edgerly, D. (2013). Birth of EMS the history of the paramedic. Journal of Emergency of Medical Services, 38(10).
Smallwood, N., & Daschel, M. (2018). Point-of-care ultrasound (POCUS): unnecessary gadgetry or evidence-based medicine? Clinical Medicine, 18(3), 219-224.