Michael R. Sayre, MD Emergency Medicine The Ohio State University

 Philips Medical: Consulting, 2004 – present.  Zoll/Revivant: Research funding, 2004 –  Medtronic Emergency Response Systems: Travel reimbursement, 2004, 2006  National Highway Traffic Safety Administration: Research funding, 1999 – 2007  Medivance: Research funding, 2004 – 2007

 Established in 1993  Thousands of collaborators worldwide  Organized in entities  Dedicated to ensuring that accurate, current information is available about the effects of healthcare interventions

 Members (usually volunteers) prepare a structured review of a specific health intervention and pledge to maintain that review regularly.

 In 2004:  > 11,500 contributors  91 countries  ~ half working on reviews

 Collaborative Review Groups  Focus on particular area of health  Groups of interest to EMS  Airways  Bone, joint, and muscle trauma  Heart  Infectious diseases  Injuries  Stroke

 Fields  Emerge around areas of interest which extend across a number of health problems  Example Fields  Behavioral medicine  Cancer network  Child health  Neurological network  Prehospital and emergency health  Vaccines

 Cochrane Centres  Geographic entities  Example Centres  Australoasian  Canadian  German  UK  US

 Central functions funded by royalties from the sales of subscriptions to the Cochrane Library.  Individual entities (Centres, etc) funded by government, institutional, & private sources.  Funds from corporate sponsors are quite limited by policy.

 Published electronically at  Updated every 3 months  Some countries have national subscriptions, e.g. Australia, allowing anyone in the country free access.  The USA does not have such a subscription.

 Initiated by Frank Archer, a physician in Melbourne, Australia in 2003 at Cochrane Colloquium in that city.  Formally constituted at Cochrane Colloquium in Ottawa in  Funded in part by the Australian government  Has more than 3,000 members worldwide

Frank Archer (Convenor) Melbourne, Australia Erin Smith (Coordinator) Melbourne, Australia Rhona Macdonald (Trials Search Coordinator) Melbourne, Australia Mal Boyle Melbourne, Australia Frederick "Skip" Burkle Jr. Baltimore, Maryland, United States Mark E. Cooke London, United Kingdom Matthew Cooke Coventry, United Kingdom Marica Ferri Rome, Italy Cameron Glass British Columbia, Canada Hugh Grantham Adelaide, Australia Ian Jacobs Perth, Australia Steve McDonald Melbourne, Australia Andrew Marsden Edinburgh, Scotland Brian Rowe Edmonton, Canada Omer Sakaf Dubai, United Arab Emirates Arturo Salazar Costa-Rica Michael Sayre Columbus, Ohio, United States Ayan Sen Manchester, United Kingdom

 Reflects references located within the Cochrane CENTRAL register of Controlled Trials, Randomized Controlled Trials, Protocols and Reviews, that are relevant to Prehospital Health

 Formalized a search strategy to identify prehospital clinical trials  Found >900 clinical trials relevant to prehospital emergency medicine  Beginning development of a disaster medicine search strategy

Smith E. Ann Emerg Med 2007; 49:

 Annals of Emergency Medicine (10.7%)  Resuscitation (8.8%)  JAMA (5%)  Prehospital Emergency Care (4%)  New Engl J Med (3.5%)  Circulation (3.3%)  American Journal Emergency Medicine (3%)  Prehospital and Disaster Medicine (2.7%)  Journal of Trauma, Injury, Infection and Crit Care (2.2%) Smith E. Ann Emerg Med 2007; 49:

 Developing EMS professionals skilled in performing evidence-based medicine reviews.  Course at Monash University in Australia  Proposal for online version of course  Two awards annually of AU$5,000 each to fund reviewers, one of which is prioritized to a EMS professional

 Cochrane reviews:  Comprehensive  Rigorous  Well accepted  But… “Absence of evidence is NOT evidence of absence.” – Carl Sagan

 Sethi, D. Kwan, I. Kelly, AM. Roberts, I. Bunn, F. Advanced trauma life support training for ambulance crews. [Systematic Review] Cochrane Injuries Group Cochrane Database of Systematic Reviews. 3,  Lecky, Fiona. Bryden, Daniele. Little, Rod. Tong, Nam. Moulton, Chris. Emergency intubation for acutely ill and injured patients. [Systematic Review] Cochrane Injuries Group Cochrane Database of Systematic Reviews. 3,  Kwan, I. Bunn, F. Roberts, I. Timing and volume of fluid administration for patients with bleeding. [Systematic Review] Cochrane Injuries Group Cochrane Database of Systematic Reviews. 3, 2008.

 Cochrane Collaboration is the International Standard for evidence-based practice reviews.  The Prehospital and Emergency Health Field is active and willing to help support additional development of evidence-based practice for EMS.

Michael R. Sayre, MD Emergency Medicine The Ohio State University