EMS in public health and evidence-based practice

1. You findA treatment has "always been done this way," and someone asks whether it actually helps.You doTreat it as a question for evidence. Evidence-based techniques are those supported by scientific evidence, not by tradition alone.
2. You findA new practice is being considered for your service.You doFollow the process: form a hypothesis, review the literature, evaluate the evidence together with the Medical Director, and adopt the practice only if the evidence supports it.
3. You findYou read about a new technique in an EMS magazine.You doWeigh the source. Peer-reviewed research has been vetted by other experts before it is published in a journal, which makes it more reliable. EMS magazines are informative but do not publish original, peer-reviewed research.
4. You findOn a call you notice loose rugs and poor lighting in an older patient's home.You doThat is public health work. Identifying fall hazards is part of injury prevention, and EMS is well placed for it because it works inside patients' homes and communities.
5. You findYou meet a patient for the first time.You doBe professional: neat uniform, introduce yourself and your crew, reassure the patient. If a partner needs correcting, do it privately and constructively, never in front of the patient.

• Public health is the system that looks after the health of a whole population: clean water, vaccination, prenatal care and the like.
• EMS contributes through: injury prevention for older adults (fall hazards, blood pressure clinics, the File of Life) and for the young (car-seat clinics, bicycle helmet programs), public vaccination programs, and disease surveillance.
• Disease surveillance: trends in call volume are an early warning of influenza, opioid overdoses and mass-casualty events.
• Mobile Integrated Health Care, also called community paramedicine, is the name for this expanded role.
• Patient outcomes are the measure that matters: long-term results, not simply survival to the hospital.
• Oxygen is the classic example. It is not a "wonder drug," and excess oxygen can worsen the outcome of a heart attack or a stroke.
• EMS research is hard: the environment is unstable, patient encounters are brief, data collection is disjointed, and consent from critically ill patients raises ethical issues.

The wrong idea: A treatment worked if the patient was still alive when we reached the hospital.

What is actually true: Survival to the hospital is a short-term result. Evidence-based practice judges care by patient outcomes, meaning long-term results. A treatment can look fine at the hospital door and still leave patients worse off later, which is what was found with oxygen given to patients who did not need it.

EMS is part of public health, the system that looks after the health of a whole population. Agencies run injury prevention for older adults and young people, take part in vaccination programs, and act as an early warning through disease surveillance; the expanded role is called Mobile Integrated Health Care or community paramedicine. Evidence-based practice means using what scientific evidence supports, judged by long-term patient outcomes, adopted with the Medical Director only when the evidence supports it, and drawn from peer-reviewed research. Oxygen is the classic example: it is not a wonder drug, and too much can worsen a heart attack or stroke. Professionalism means a neat appearance, introducing yourself, reassuring the patient and correcting colleagues in private.

Well-being and standard precautions →