Implementing Prehospital Evidence-Based Guidelines: A Systematic Literature Review

Area of Science:

• Emergency Medical Services Research
• Translational Science
• Healthcare Quality Improvement

Background:

• Evidence-based guidelines (EBGs) are increasingly integrated into emergency medical services (EMS) practice.
• Suboptimal implementation of prehospital EBGs can impede improvements in patient outcomes.
• Understanding effective implementation methods is vital for advancing prehospital care.

Purpose of the Study:

• To systematically review existing evidence on prehospital EBG implementation methods.
• To identify successful strategies and barriers in translating EBGs into EMS practice.
• To inform future research and practice for better EBG adoption.

Main Methods:

• Systematic literature review using GRADE methodology.
• Searched PubMed, EMBASE, Scopus, and Google Advanced Search without date or language restrictions.
• Excluded conference proceedings, textbooks, and non-English articles; applied GRADE for evidence evaluation.

Main Results:

• 41 articles met inclusion criteria; most focused on EBG implementation (59%) or barriers (32%).
• Evidence quality was predominantly low or very low.
• Key findings include the dependence of outcomes on implementation, lack of detailed methods in studies, implementation delays, heterogeneity of EMS systems, and numerous barriers (financial, regulatory, coordination).

Conclusions:

• While implementation barriers are documented, optimal prehospital EBG implementation methods lack robust evidence.
• Translating EBG development into effective EMS practice requires further research.
• Future studies should compare methodologies across diverse prehospital settings to define best practices.