The JRCALC Clinical Guidelines Dr Iain McNeil Medical Director, Surrey Ambulance Service Associate Medical Director, Kent Ambulance Service

Only those who do nothing make no mistakes JRCALC guidelines n The need n History n Where we are now n The short term future n The medium term future n The long term future JRCALC

Only those who do nothing make no mistakes The need n Public expectations n Clinical Governance –Clinical Audit n benchmarking –Risk Management –Educational base n Evidence base JRCALC

Only those who do nothing make no mistakes History n IHCD training manuals n Individual service guidelines n Staffordshire guidelines n Joint review of “Carney protocols” n ASA/JRCALC effectiveness committee n Department of Health n JRCALC endorsement JRCALC

Only those who do nothing make no mistakes Where we are now n “Carney protocols” now ‘Medical Directors Guidelines’ n NO claim to be perfect!! n Reviewed by JRCALC experts n Endorsed as “interim” n Ready for use in number of services n Agreed starting point for future work JRCALC

Only those who do nothing make no mistakes We MUST overcome prejudices JRCALC To have a future

Only those who do nothing make no mistakes The short term future n National Association of Air Ambulance Services (NAAAS) n IHCD n Medical Directors Group n Meeting December to establish commonality with NAAAS n Merge NAAAS and JRCALC evidence bases JRCALC

Only those who do nothing make no mistakes The medium term future n Merge JRCALC work with NAAAS n Publish on web and CD n Develop audit processes with ASANCEP n Develop evidence base where it is absent n Update in light of evidence n Go through ECC weighting process JRCALC

Only those who do nothing make no mistakes The ECC process n Agree start point n Gather evidence n Determine level of evidence * n Critically evaluate quality of evidence n Summarise the evidence n Determine class of recommendation * n Draft guideline

Only those who do nothing make no mistakes Levels of evidence n Level 1Randomized clinical trials or meta- analyses of multiple clinical trials with substantial treatment effects n Level 2Randomized clinical trials with smaller or less significant treatment effects n Level 3Prospective, controlled, non-randomized, cohort studies n Level 4Historic, non-randomized, cohort or case- control studies AHA-ECC, Levels of evidence 1998

Only those who do nothing make no mistakes Levels of evidence n Level 5Case series: patients compiled in serial fashion, lacking a control group n Level 6Animal studies or mechanical model studies n Level 7Extrapolations from existing data collected for other purposes, theoretical analyses n Level 8Rational conjecture (common sense); common practices accepted before evidence-based guidelines AHA-ECC, Levels of evidence 1998 AHA-ECC, Levels of evidence 1998

Only those who do nothing make no mistakes Class of evidence n Class I –excellent evidence: always acceptable n Class II a –good - very good: considered best practice by majority n Class II b –fair to good:considered acceptable alternative by majority

Only those who do nothing make no mistakes Class of evidence n Indeterminate –insufficient evidence or preliminary research evidence n Class III –Harmful, Unacceptable

Only those who do nothing make no mistakes The long term future n Secure funding for evidence base work n Secure funding for ASANCEP n Develop national audit facility n Develop co-ordinated national R&D facility JRCALC

Only those who do nothing make no mistakes Summary n Interim guidelines are ready n Evidence base must be developed n Work must be funded n We must work together to secure a safe future n We must share! JRCALC

Only those who do nothing make no mistakes Any questions? JRCALC