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Abstract P41: How to Implement International Recommendations in Daily Practice in a Large EMS Center


 Introduction:
 Continuous professional development and education associated with Evaluation of health Professional Practices (EPP) has been legally implemented and is mandatory in France since 2004. EPP applies to all aspects of the health care system, including pre-hospital EMS and their call centers. EPP must comply with one of the restricted proposals issued by Health Authorities. The aim of this presentation is to lay out the methodology selected to achieve this legal requirement in an EMS serving 1.5 million population.
 
 
 Methods:
 The proposed methods were: clinical audit compared with standards, identification of existing procedures, identification of clinical decision trees, identification of patient's pathway to optimised final care. Among these methods, identification of patient's clinical pathway was selected as the best method for a call center study, since it allows to monitor the overall handling of an emergency call, from the early phone call to the final point of care. Among the various pathologies, cardiac arrest was selected because: 1 - The release of new AHA recommendations in 2010, 2 - Similar “cardiac arrest” EPP developments in the hospital where the EMS is based, 3 - The need for quality control of all cardiac arrest calls.
 
 
 Expected results:
 EPP in the EMS is divided in 3 steps: Step 1: results from studying the running procedures, regarding call handling of cardiac arrests including triage performed by operators and medical dispatchers (physicians). Retrospective study of files that were triaged as cardiac arrests by operators. Duration: 6 months. Step 2: elaboration of an action plan: Sharing of the results with operators and medical dispatchers. Setting up of a global team training program for both operators and physicians, in agreement with new AHA guidelines. Duration: 6 months. Step 3: new retrospective study based on the same methodology than step 1, done after 6 months. The comparison of results of both studies will lead to the selection of pertinent indicators allowing continuous quality control.
 
 
 Conclusion:
 This EPP aims at evaluating and improving the management of emergency calls. It is expected to bring other benefits, such as easing the implementation of new guidelines, or defining new indicators for a continuous quality control.
