Delayed prehospital implementation of the 2005 American Heart Association guidelines for cardiopulmonary resuscitation and emergency cardiac care.
BACKGROUND
In 2005, the American Heart Association (AHA) released guidelines to improve survival rates from out-of-hospital cardiac arrest (OHCA).


OBJECTIVE
To determine if, and when, emergency medical services (EMS) agencies participating in the Resuscitation Outcomes Consortium (ROC) implemented these guidelines.


METHODS
We contacted 178 EMS agencies and completed structured telephone interviews with 176 agencies. The survey collected data on specific treatment protocols before and after implementation of the 2005 guidelines as well as the date of implementation crossover (the "crossover date"). The crossover date was then linked to a database describing the size, type, and structure of each agency. Descriptive statistics and regression were used to examine patterns in time to crossover.


RESULTS
The 2005 guidelines were implemented by 174 agencies (99%). The number of days from guideline release to implementation was as follows: mean 416 (standard deviation 172), median 415 (range 49-750). There was no difference in time to implementation in fire-based agencies (mean 432), nonfire municipal agencies (mean 365), and private agencies (mean 389, p = 0.31). Agencies not providing transport took longer to implement than agencies that transported patients (463 vs. 384 days, p = 0.004). Agencies providing only basic life support (BLS) care took longer to implement than agencies who provided advanced life support (ALS) care (mean 462 vs. 397 days, p = 0.03). Larger agencies (>10 vehicles) were able to implement the guidelines more quickly than smaller agencies (mean 386 vs. 442 days, p = 0.03). On average, it took 8.9 fewer days to implement the guidelines for every 50% increase in EMS-treated runs/year to which an agency responded.


CONCLUSIONS
ROC EMS agencies required an average of 416 days to implement the 2005 AHA guidelines for OHCA. Small EMS agencies, BLS-only agencies, and nontransport agencies took longer than large agencies, agencies providing ALS care, and transport agencies, respectively, to implement the guidelines. Causes of delays to guideline implementation and effective methods for rapid EMS knowledge translation deserve investigation.
Bigham
Blair L
BL
Rescu, Keenan Research Centre, Li Ka Shing Knowledge Institute, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada M5B1W8. bighamb@smh.toronto.on.cawww.rescu.ca
Koprowicz
Kent
K
Aufderheide
Tom P
TP
Davis
Daniel P
DP
Donn
Stuart
S
Powell
Judy
J
Suffoletto
Brian
B
Nafziger
Sarah
S
Stouffer
John
J
Idris
Ahamed
A
Morrison
Laurie J
LJ
D000572:American Heart Association; D002170:Canada; D016887:Cardiopulmonary Resuscitation / Q000379:methods*; D004632:Emergency Medical Services; D019983:Guideline Adherence; D017408:Guidelines as Topic; D019538:Health Care Surveys; D006323:Heart Arrest / Q000628:therapy; D006801:Humans; D014481:United States
CJEM. 2008 Mar;10(2):125-30
18371250
Resuscitation. 2008 Mar;76(3):354-9
17936491
Crit Care Med. 2006 Jul;34(7):1935-40
16691134
Resuscitation. 2005 Feb;64(2):181-6
15680527
Resuscitation. 2010 Jan;81(1):20-4
19913981
JAMA. 2008 Sep 24;300(12):1423-31
18812533
N Engl J Med. 2003 Jun 26;348(26):2635-45
12826639
Prehosp Emerg Care. 2007 Oct-Dec;11(4):369-82
17907019
Semin Oncol. 1990 Aug;17(4):485-94
2201091
Circulation. 2005 Dec 13;112(24 Suppl):IV1-203
16314375
Acad Emerg Med. 2007 Nov;14(11):1052-7
17761547