title: Knowledge translation in emergency medical services: a qualitative survey of barriers to guideline implementation.
abstract: BACKGROUND
  The American Heart Association (AHA) released guidelines to improve survival rates from out-of-hospital cardiac arrest in 2005. We sought to identify what barriers delayed the implementation of these guidelines in EMS agencies.
  
  
  METHODS
  We surveyed 178 EMS agencies as part of a larger quantitative survey regarding guideline implementation and conducted a single-question semi-structured interview using the Grounded Theory method. We asked "What barriers if any, delayed implementation of the (2005 AHA) guidelines in your EMS agency?" Data were coded and member validation was employed to verify our findings.
  
  
  RESULTS
  176/178 agencies completed the quantitative survey. Qualitative data collection ceased after reaching theoretical saturation with 34 interviews. Ten unique barriers were identified. We categorized these 10 barriers into three themes. The theme instruction delays (reported by 41% of respondents) included three barriers: booking/training instructors (9%), receiving training materials (15%), and scheduling staff for training (18%). The second theme, defibrillator delays (38%), included two barriers; reprogramming defibrillators (24%) and receiving new defibrillators to replace non-upgradeable units (15%). The third theme was decision-making (38%) and included five barriers; coordinating with allied agencies (9%), government regulators such as state and provincial health authorities (9%), medical direction and base hospitals (9%), ROC participation (9%), and internal crises (3%).
  
  
  CONCLUSIONS
  Many barriers contributed to delays in the implementation of the 2005 AHA guidelines in EMS agencies. These identified barriers should be proactively addressed prior to the 2010 Guidelines to facilitate rapid translation of science into clinical practice.
authors.affiliation: Rescu, Keenan Research Centre, Li Ka Shing Knowledge Institute, St. Michael's Hospital, University of Toronto, Toronto, Canada. bighamb@smh.toronto.on.ca
authors.forename: Blair L
authors.initials: BL
authors.lastname: Bigham
authors.forename: Tom P
authors.initials: TP
authors.lastname: Aufderheide
authors.forename: Daniel P
authors.initials: DP
authors.lastname: Davis
authors.forename: Judy
authors.initials: J
authors.lastname: Powell
authors.forename: Stuart
authors.initials: S
authors.lastname: Donn
authors.forename: Brian
authors.initials: B
authors.lastname: Suffoletto
authors.forename: Sarah
authors.initials: S
authors.lastname: Nafziger
authors.forename: John
authors.initials: J
authors.lastname: Stouffer
authors.forename: Laurie J
authors.initials: LJ
authors.lastname: Morrison
mesh_terms: D000572:American Heart Association; D002170:Canada; D016887:Cardiopulmonary Resuscitation / Q000592:standards* / Q000639:trends; D002983:Clinical Competence; D004632:Emergency Medical Services / Q000592:standards*; D005260:Female; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D019538:Health Care Surveys; D006323:Heart Arrest / Q000401:mortality / Q000628:therapy*; D006801:Humans; D008297:Male; D017410:Practice Guidelines as Topic; D011787:Quality of Health Care; D018570:Risk Assessment; D016019:Survival Analysis; D014481:United States
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