Translation of Evidence-Based Clinical Standards into a New Prehospital Resuscitation Policy in Los Angeles

In an example of “community-partnered participatory research,” an EMS agency and a research team collaborated to rapidly develop and implement changes to guidelines regarding cardiopulmonary resuscitation, demonstrating evidence-based research can influence policy and benefit patients.

There are significant challenges to integrating research knowledge into health care practices. The approach of community-partnered participatory research relies on creation of a collaborative partnership between researchers and a “practice” group, who engage in an iterative process of integrating research information into practice guidelines. In this study, UCLA researchers collaborated with Los Angeles County EMS leadership to develop and implement guidelines to decrease “unnecessary and potentially harmful” cardiopulmonary resuscitation attempts in non-traumatic patients. The “Collaboration” identified and gathered evidence, proposed protocols, and supported and revised the proposal throughout a multi-layered county review and implementation process that included medical experts and community representatives.

Key Findings:

  • The process did “rapidly translate evidence into policy” in about a year, from June 2006 through July 2007, because the group identified a solvable goal and worked regularly and collaboratively.
  • Ten of the 22 standards the Collaboration suggested were enacted.
  • All six standards related to do not attempt resuscitation (DNAR) requests were included.
  • Only four of the 16 standards based on patient characteristics were included, reflecting both medical disagreements and community cultural values that translated into a reluctance to enact policies to withhold resuscitation attempts.

Subsequent evaluation shows the policy has significantly reduced resuscitation attempts. The authors note this case suggests a collaborative participatory approach can translate evidence into practice quickly, but requires an “immense investment of time and energy” and must recognize the skills and constraints of policy-makers and researchers.