The Cochrane Collaboration

1. Michael R. Sayre, MD Emergency Medicine The Ohio State University The Cochrane Collaboration

2. Competing Interests • Philips Medical: Consulting, 2004 – present. • Zoll/Revivant: Research funding, 2004 – 2006. • Medtronic Emergency Response Systems: Travel reimbursement, 2004, 2006 • National Highway Traffic Safety Administration: Research funding, 1999 – 2007 • Medivance: Research funding, 2004 – 2007

3. What is the Cochrane Collaboration? • Established in 1993 • Thousands of collaborators worldwide • Organized in entities • Dedicated to ensuring that accurate, current information is available about the effects of healthcare interventions

4. How the Cochrane Collaboration Works • Members (usually volunteers) prepare a structured review of a specific health intervention and pledge to maintain that review regularly.

5. Scope of the Collaboration • In 2004: • > 11,500 contributors • 91 countries • ~ half working on reviews

6. Structure & Management • Collaborative Review Groups • Focus on particular area of health • Groups of interest to EMS • Airways • Bone, joint, and muscle trauma • Heart • Infectious diseases • Injuries • Stroke

7. Structure & Management • Fields • Emerge around areas of interest which extend across a number of health problems • Example Fields • Behavioral medicine • Cancer network • Child health • Neurological network • Prehospital and emergency health • Vaccines

8. Structure & Management • Cochrane Centres • Geographic entities • Example Centres • Australoasian • Canadian • German • UK • US

9. Funding • Central functions funded by royalties from the sales of subscriptions to the Cochrane Library. • Individual entities (Centres, etc) funded by government, institutional, & private sources. • Funds from corporate sponsors are quite limited by policy.

11. Where to Find Cochrane Reviews • Published electronically at www.TheCochraneLibrary.com • Updated every 3 months • Some countries have national subscriptions, e.g. Australia, allowing anyone in the country free access. • The USA does not have such a subscription.

14. Cochrane Prehospital & Emergency Health Field

16. About the Cochrane Prehospital & Emergency Health Field (CPEHF) • Initiated by Frank Archer, a physician in Melbourne, Australia in 2003 at Cochrane Colloquium in that city. • Formally constituted at Cochrane Colloquium in Ottawa in 2004. • Funded in part by the Australian government • Has more than 3,000 members worldwide

17. CPEHF Advisory Board Frank Archer (Convenor) Melbourne, Australia Erin Smith (Coordinator) Melbourne, Australia Rhona Macdonald (Trials Search Coordinator) Melbourne, Australia Mal Boyle Melbourne, Australia Frederick "Skip" Burkle Jr. Baltimore, Maryland, United States Mark E. Cooke London, United Kingdom Matthew Cooke Coventry, United Kingdom Marica Ferri Rome, Italy Cameron Glass British Columbia, Canada Hugh Grantham Adelaide, Australia Ian Jacobs Perth, Australia Steve McDonald Melbourne, Australia Andrew Marsden Edinburgh, Scotland Brian Rowe Edmonton, Canada Omer Sakaf Dubai, United Arab Emirates Arturo Salazar Costa-Rica Michael Sayre Columbus, Ohio, United States Ayan Sen Manchester, United Kingdom

18. Specialized Trials Register • Reflects references located within the Cochrane CENTRAL register of Controlled Trials, Randomized Controlled Trials, Protocols and Reviews, that are relevant to Prehospital Health

19. Search Results • Formalized a search strategy to identify prehospital clinical trials • Found >900 clinical trials relevant to prehospital emergency medicine • Beginning development of a disaster medicine search strategy

20. Category of Prehospital Controlled Clinical Trials and Randomized Controlled Trials Smith E. Ann Emerg Med 2007; 49:344-350.

21. Year of Publication Smith E. Ann Emerg Med 2007; 49:344-350.

22. Journals of Publication – Controlled Clinical Trials & Randomized Controlled Trials • Annals of Emergency Medicine (10.7%) • Resuscitation (8.8%) • JAMA (5%) • Prehospital Emergency Care (4%) • New Engl J Med (3.5%) • Circulation (3.3%) • American Journal Emergency Medicine (3%) • Prehospital and Disaster Medicine (2.7%) • Journal of Trauma, Injury, Infection and Crit Care (2.2%) Smith E. Ann Emerg Med 2007; 49:344-350.

23. Education Goals • Developing EMS professionals skilled in performing evidence-based medicine reviews. • Course at Monash University in Australia • Proposal for online version of course • Two awards annually of AU$5,000 each to fund reviewers, one of which is prioritized to a EMS professional

24. What Can We Learn from the Cochrane Collaboration • Cochrane reviews: • Comprehensive • Rigorous • Well accepted • But… “Absence of evidence is NOT evidence of absence.” – Carl Sagan

25. Few Cochrane Reviews Completed • Sethi, D. Kwan, I. Kelly, AM. Roberts, I. Bunn, F. Advanced trauma life support training for ambulance crews. [Systematic Review] Cochrane Injuries Group Cochrane Database of Systematic Reviews. 3, 2008. • Lecky, Fiona. Bryden, Daniele. Little, Rod. Tong, Nam. Moulton, Chris. Emergency intubation for acutely ill and injured patients. [Systematic Review] Cochrane Injuries Group Cochrane Database of Systematic Reviews. 3, 2008. • Kwan, I. Bunn, F. Roberts, I. Timing and volume of fluid administration for patients with bleeding. [Systematic Review] Cochrane Injuries Group Cochrane Database of Systematic Reviews. 3, 2008.

26. Conclusions • Cochrane Collaboration is the International Standard for evidence-based practice reviews. • The Prehospital and Emergency Health Field is active and willing to help support additional development of evidence-based practice for EMS.

27. Michael R. Sayre, MD Emergency Medicine The Ohio State University Michael.Sayre@osumc.edu Questions?