Abstract 4034: Barriers to Guideline Implementation: A Qualitative Survey of Emergency Medical Services
In 2005, the AHA released guidelines to improve survival rates from out-of-hospital cardiac arrest. We sought to identify what barriers slowed the implementation of these guidelines in EMS agencies participating in the Resuscitation Outcomes Consortium (ROC). We contacted the training departments at 176 EMS agencies at 8 of 10 ROC sites as part of a larger quantitative survey regarding guideline implementation and conducted a single-question semi-structured interview using the Grounded Theory method. This qualitative interview was initiated if the interviewee discussed barriers to implementation during the quantitative interview. The question asked was “What, if any, barriers delayed implementation of the (2005 AHA) guidelines in your EMS agency?” 174/178 agencies completed the quantitative survey. Of those, 34 initiated a discussion about barriers (20%) and responded to the qualitative question. Some agencies reported multiple barriers. Ten unique barriers were identified as causes of delayed implementation of the 2005 AHA guidelines. We categorized these ten 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%). Theoretical saturation was reached early in the data collection period. 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.