Utstein-like template for physician EMS

Many European and Australasian emergency medical services deploy physicians to the scene. In order to facilitate consistent data reporting and future collaborative research, a working group produced a recommended reporting template. The group consisted of ‘sixteen European experts in the field of pre-hospital care’, and the nine authors of the study were seven Scandinavians, one Italian and one Brit.

Prehospital Care Doctors
They established an Utstein-like template for documenting and reporting in physician-staffed pre-hospital services. The core data set consists of 45 variables grouped in five different categories: “fixed system variables”, “event operational descriptors”, ” patient descriptors”, “process mapping”, and “outcome measures and quality indicators”.

A consensus-based template for documenting and reporting in physician-staffed pre-hospital services
Andreas J Kruger, David Lockey, Jouni Kurola, Stefano Di Bartolomeo, Maaret Castren, Soren Mikkelsen, Hans Morten Lossius
Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine 2011, 19:71 Full Text
Full text PDF

5 thoughts on “Utstein-like template for physician EMS”

  1. Hi Cliff. Thanks for highlighting this important article. If we are to advance the discipline of prehospital and retrieval medicine as a distinct specialist practice then we need to establish good evidence and research base, academic positions and professors of the body of knowledge and skill. At the ASA/FNA meeting in August this year in Cairns we are debating the topic of formation of a prehospital and retrieval medicine college and this article is timely.
    It was intended to improve consistency in data collection for Scandinavian prehospital services so I can forgive them for having majority Scandinavian experts although David Lockey was included! I do not understand the persistent fascination with examining the medical specialty background of the prehospital physician! In reality it is the training and assessed competency for prehospital critical care and emergency medicine that matters , not what a physicians primary specialty training. This perpetuates the mistaken belief that hospital based training is the primary determinant of a doctors ability to survive, thrive and deliver effective care in the prehospital and retrieval setting. I am not sure why they decided that long term hospital outcomes were too hard to gather. to me this is the most important factor to try to determine if we want to prove that prehospital care by trained doctors actually improves long term morbidity and mortality. its hard but not impossible. As you know theHIRT trial in Sydney had a good crack and trying to gather that sort of data.
    Bernards study from Melbourne MICA group actually achieved that aim although there was some lost to long term followup.
    The other variables they promote seem reasonable. we need more of this kind of academic discourse to progress the profession.

    1. Thanks Minh
      I had exactly the same thought about the obsession with hospital specialty background – does it mean that the new cadre of prehospital emergency medicine specialists that will be trained specifically for this purpose in the UK will have to tick the ‘Other’ box?! Seems a bit 20th Century to me.

  2. Dear friends, thanks for discussing our paper! It’s very interesting to read your comments from your perspective.
    Minh makes some important comments relating to outcome: Our expert panel agreed that “hard” outcome measures are very, very important. Nevertheless, as this is the first version of the template, they decided to put priority to data currently collectable in our setting. outcomes such as long term survival is indeed the most important one, but, at least, in Scandinavia physician-staffed pre-hospital services typically deliver patients to a large number of hospitals. We currently do not have access to hospital records. Another perspective is the problem to isolate the effect of whats happening in the pre-hospital phase, bad pre-hospital management can be adjusted by superior in-hospital treatment, and superior pre-hospital treatment can be damaged by bad in-hospital treatment when assessing long-term outcomes. As such, we believe that a robust indicator of treatment effect and quality isolated to the pre-hospital phase is what we need. We are currenty working on that one, but its hard.
    ad medical speciality; I totally agree that medical speciality in not the most important factor in pre-hospital care, but we believe its important to have it documented as it must be a part of “system characteristics”. The “fixed system variables” is intended to be reported as background information in all reports concerning pre-hospital care. These variables can significantly affect comparability of services in multi-centered research. At least in our system the formal comptency of the staffing physician will relate to the medical capacity of the service ( e.g if the service are capable of doing incubator transports of prematures/ advanced intensive care transports).
    And, our paper is done with a scandinavian perspective, nevertheless, several experts from Europe participated (Holland, Germany, Switzerland, Austria, and Italy). We are currently working on feasibility testing of the template, and we hope standarization of documenting can facilitate knowledge generation in the future.

    1. Thanks very much for your comments Andreas. I think we have a responsibility to evaluate the effectiveness of our physician-based services and your work provides an important step forward. I think the specialty background point is going to be an issue internationally, since some countries use the term ’emergency physician’ specifically for prehospital doctors, some having just done a course for a few weeks. It’s also going to be hard differentiating trained specialists from trainees (registrars/residents).
      International collaborative research studies are an exciting development – we’re delighted to be contributing to the Norwegian-instigated AIRPORT study.
      Best wishes

  3. Hi guys
    thankyou for your feedback Andreas and Cliff. we need more discussions like this! The arguement that it is difficult to eliminate the confounding factor of hospital care on the effect of good or bad prehospital care and vice versa is somewhat convoluted I find. You assume that by dividing the prehospital doctor into distinct specialities you are defining a uniform group per discipline with the same skill sets and competenscies. This is far from reality. Some anaesthetists are gods in the prehospital setting. Others are terrible and I would rather have a decent paramedic do the job.this is more of a confounder than eventual hospital care!
    What is needed is to define a standard training skill set and competency based program like what has been done in the UK..and examine that using an agreed data template! Some services are moving towards formal competency based training programs for their prehospital doctor services. I would love to interview Cliff about his program! My service has introduced a 6month exam based training program with higher level university based qualification. If you define a standard level of prehospital doctor competency then you can research the care provided with less confounders.
    If anyone is interested in is topic. come and hear Cliff and his mate Karel, talk about their training program in their Sydney HEMS unit at the ASA/FNAmeeting in Cairns in last week of August! What they do is high fidelity simulation based comprehensive curriculum based prehospital training and everyone is trained to a standard that is assessable. Regardless of physician background!

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