The JRCALC Clinical Guidelines Dr Iain McNeil Medical Director, Surrey Ambulance Service Associate...
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Transcript of The JRCALC Clinical Guidelines Dr Iain McNeil Medical Director, Surrey Ambulance Service Associate...
The JRCALC Clinical The JRCALC Clinical GuidelinesGuidelines
Dr Iain McNeilDr Iain McNeilMedical Director, Surrey Ambulance ServiceMedical Director, Surrey Ambulance Service
Associate Medical Director, Kent Ambulance Associate Medical Director, Kent Ambulance ServiceService
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JRCALC guidelinesJRCALC guidelines
The needThe need HistoryHistory Where we are nowWhere we are now The short term futureThe short term future The medium term futureThe medium term future The long term futureThe long term future
JRCALC
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The needThe need Public expectationsPublic expectations Clinical GovernanceClinical Governance
– Clinical AuditClinical Audit benchmarkingbenchmarking
– Risk ManagementRisk Management– Educational baseEducational base
Evidence baseEvidence base
JRCALC
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HistoryHistory
IHCD training manualsIHCD training manuals Individual service guidelinesIndividual service guidelines Staffordshire guidelinesStaffordshire guidelines Joint review of “Carney protocols”Joint review of “Carney protocols” ASA/JRCALC effectiveness committeeASA/JRCALC effectiveness committee Department of HealthDepartment of Health JRCALC endorsementJRCALC endorsement
JRCALC
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Where we are nowWhere we are now
““Carney protocols” now ‘Medical Carney protocols” now ‘Medical Directors Guidelines’Directors Guidelines’
NONO claim to be perfect!! claim to be perfect!! Reviewed by JRCALC expertsReviewed by JRCALC experts Endorsed as “interim”Endorsed as “interim” Ready for use in number of servicesReady for use in number of services Agreed starting point for future workAgreed starting point for future work
JRCALC
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We MUST We MUST overcomovercom
e e prejudiceprejudice
ss
JRCALC
To have a future
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The short term futureThe short term future National Association of Air National Association of Air
Ambulance Services (NAAAS)Ambulance Services (NAAAS) IHCDIHCD Medical Directors GroupMedical Directors Group Meeting December to establish Meeting December to establish
commonality with NAAAScommonality with NAAAS Merge NAAAS and JRCALC evidence Merge NAAAS and JRCALC evidence
basesbases
JRCALC
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The medium term future The medium term future
Merge JRCALC work with NAAASMerge JRCALC work with NAAAS Publish on web and CDPublish on web and CD Develop audit processes with Develop audit processes with
ASANCEPASANCEP Develop evidence base where it is Develop evidence base where it is
absentabsent Update in light of evidenceUpdate in light of evidence Go through ECC weighting processGo through ECC weighting process
JRCALC
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The ECC processThe ECC process
Agree start pointAgree start point Gather evidence Gather evidence Determine level of evidence *Determine level of evidence * Critically evaluate quality of evidenceCritically evaluate quality of evidence Summarise the evidenceSummarise the evidence Determine class of recommendation *Determine class of recommendation * Draft guidelineDraft guideline
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Levels of evidenceLevels of evidence
Level 1Level 1 Randomized clinical trials or meta-Randomized clinical trials or meta-analyses of multiple clinical trials analyses of multiple clinical trials
with with substantial treatment effectssubstantial treatment effects Level 2Level 2 Randomized clinical trials with Randomized clinical trials with
smaller or smaller or less significant treatment less significant treatment effectseffects
Level 3Level 3 ProspectiveProspective, controlled, non-, controlled, non-randomized, randomized, cohort studiescohort studies
Level 4Level 4 HistoricHistoric, non-randomized, cohort or , non-randomized, cohort or case-case- control studiescontrol studies
AHA-ECC, Levels of evidence 1998
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Levels of evidenceLevels of evidence Level 5Level 5 Case series:Case series: patients compiled in serial patients compiled in serial
fashion, lacking a control groupfashion, lacking a control group Level 6Level 6 Animal studies or mechanical model Animal studies or mechanical model
studiesstudies Level 7Level 7 Extrapolations from existing data Extrapolations from existing data
collected collected for other purposes, theoretical analysesfor other purposes, theoretical analyses
Level 8Level 8 Rational conjecture (common sense); Rational conjecture (common sense); common practices accepted before common practices accepted before evidence-based guidelines evidence-based guidelines
AHA-ECC, Levels of evidence 1998AHA-ECC, Levels of evidence 1998
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Class of evidenceClass of evidence Class IClass I
– excellent evidence: always acceptableexcellent evidence: always acceptable Class II aClass II a
– good - very good: considered best good - very good: considered best practice by majority practice by majority
Class II bClass II b– fair to good:considered acceptable fair to good:considered acceptable
alternative by majorityalternative by majority
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Class of evidenceClass of evidence
IndeterminateIndeterminate– insufficient evidence or preliminary insufficient evidence or preliminary
research evidenceresearch evidence Class IIIClass III
– Harmful, Unacceptable Harmful, Unacceptable
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The long term futureThe long term future
Secure funding for Secure funding for evidence base workevidence base work
Secure funding for Secure funding for ASANCEPASANCEP
Develop national Develop national audit facilityaudit facility
Develop co-Develop co-ordinated national ordinated national R&D facilityR&D facility
JRCALC
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SummarySummary Interim guidelines are Interim guidelines are
readyready Evidence base must Evidence base must
be developedbe developed Work must be fundedWork must be funded We must work We must work
together to secure a together to secure a safe future safe future
We must share!We must share!
JRCALC
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Any questions?Any questions?
JRCALC