Q - How did you decide on the organization of protocols and types of interventions?
A - This was based upon reviewing approximately twenty (20) other EMS systems protocols. Although each organization grouped their protocols and interventions slightly different, there were many similarities. From this review, our protocols were arbitrarily organized according to what we thought made intuitive sense in addition, we also wanted to maintain consistency with the AHA-ECC cardiac arrest guidelines and the EMS-C Model for pediatric protocols.
Q - How did you deal with grade 1 evidence found in an in-hospital study?
A - This was difficult. For example, B2 agonists (i.e. salbutamol) for the treatment of asthma in most in-hospital clinical practices is a level I intervention. However, in the prehospital environment this can not necessarily be transposed [i.e. more difficult to diagnose, does it make a difference getting it five (5) minutes versus twenty (20) minutes earlier. Thus, because these questions have not been answered in the prehospital setting it was agreed upon to arbitrarily drop the grade of recommendation by one (1).
