dr-exmedic.com

Here’s a study on something I never would have even thought to study:  implementing national guidelines.  More specifically, how long does it take to change over from old practices (in this case, the 2000 AHA guidelines) to new ones (the 2005 recommendations).  As with most things in medicine, the answer comes down to:  it depends.

The study looked at the time between the publication of the guidelines (12/13/05) to the end of the training period when all personnel began using them.  The first hint of any problems begins even before the results section:  2 agencies were excluded from data analysis because they had not yet begun using the 2005 guidelines when the agencies were surveyed…in March 2008.  Keep in mind that surveys were sent strictly to members of the Resuscitation Outcomes Consortium, who (in theory at least) should be a bit ahead of the trend.

Of the remaining agencies, there was a huge amount of variation:  agencies crossed over as quickly as 49 days (wow!) and as slowly as 750 days, with an average of 416.  With a median of 415 days, there were just as many agencies below the average as above it.

Interestingly, larger agencies seemed to implement the guidelines faster:  agencies with more than 10 vehicles made the switch more than 50 days earlier, on average, which probably reflects more personnel dedicated to training.  BLS-only agencies took longer than their ALS-offering counterparts (about 65 days difference), and non-transporting agencies took longer than their transporting counterparts (by almost 80 days).  The only difference looked for that didn’t reach statistical significance:  agency type, with fire, non-fire governmental, and private agencies performing statistically similar.

This is just another way of pointing out that “once you’ve seen one EMS agency, you’ve seen one EMS agency.”  With uptake times of 2 months to 2 years or more, and every number in between, it’s pretty obvious that the care you receive is determined more by where you call 911 than any other factor.