The development of evidence-based prehospital guidelines using a GRADE-based methodology.

Area of Science:

• Emergency Medical Services
• Clinical Guideline Development
• Evidence-Based Practice

Background:

• Prehospital care literature necessitates standardized evidence-based guidelines (EBGs) due to existing protocol variability.
• A National Prehospital EBG Model Process was recently approved to guide EBG development, implementation, and evaluation.
• The model process recommends tools like Grading of Recommendations, Assessment, Development, and Evaluation (GRADE).

Purpose of the Study:

• To describe the development of three prehospital EBGs.
• Utilized the National Prehospital EBG Model Process and the GRADE EBG development tool.
• Demonstrated a structured approach to creating prehospital clinical guidelines.

Main Methods:

• Employed three iterations of the EBG Model Process with the GRADE tool.
• Included expert panel assembly, PICO question formulation, outcome prioritization, and GRADE table creation.
• Synthesized recommendations into EMS protocols and visual algorithms with stakeholder feedback.

Main Results:

• Successfully developed three prehospital EBGs formatted as decision tree algorithms.
• Guidelines incorporated levels of evidence and graded recommendations at each decision point.
• The process was resource-intensive, with potential for further resource needs for improvements.

Conclusions:

• The National Prehospital EBG Model Process yields credible, transparent, and usable prehospital EBGs.
• A centralized or regionalized approach is recommended for creating and maintaining prehospital EBGs.
• Optimizing resource utilization is key for comprehensive EBG development and maintenance.