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  1. Developing a foundation for the evaluation of expanded-scope EMS : A window of opportunity that cannot be ignored.

    Article - En anglais

    EMS systems are about to undergo a major transformation.

    Not only will the scope of EMS change, but many experts believe that it will dramatically expand.

    Some see the « expanded scope » as entailing relatively limited changes, whereas others consider them to be more broad.

    Although no agreement is evident about the definition for expanded-scope EMS, it is hoped that all EMS professionals can agree that it must be implemented in a manner that can be carefully evaluated to determine its effects on patients and EMS systems.

    We present a framework for evaluating the effect of expanded-scope EMS in the various types of systems that currently exist.

    Special consideration must be given to the indirect effects that system changes may have on survival from out-of-hospital cardiac arrest.

    Numerous issues will affect our ability to properly assess expanded-scope EMS.

    The basic research models necessary to assess the impact of system change are lacking.

    Few EMS systems consistently produce significant volumes of good systems research ... that is, there are few « EMS laboratories. » Cost-effectiveness and issues surrounding the « societal value » of EMS remain essentially unstudied.

    Reliable scoring methods, severity scales, and outcome measures are lacking ; and, it is ethically and logistically difficult to justify withholding the « standard of care » in an effort to understand the impact of EMS interventions. (...)

    Mots-clés Pascal : Médecine, Urgence, Service santé, Analyse coût efficacité, Economie santé, Arrêt cardiocirculatoire, Période préhospitalière, Survie, Epidémiologie, Evaluation, Méthodologie, Homme, Etats Unis, Amérique du Nord, Amérique, Soin intensif, Appareil circulatoire pathologie

    Mots-clés Pascal anglais : Medicine, Emergency, Health service, Cost efficiency analysis, Health economy, Cardiocirculatory arrest, Prehospital period, Survival, Epidemiology, Evaluation, Methodology, Human, United States, North America, America, Intensive care, Cardiovascular disease

    Logo du centre Notice produite par :
    Inist-CNRS - Institut de l'Information Scientifique et Technique

    Cote : 98-0052260

    Code Inist : 002B30A01A1. Création : 14/05/1998.