Evidence based practice from the ashes of clinical freedom

Evidence based practice largely owes its rise to a battle fought within medicine in the 1980s. The debate at the time was about rise of protocols derived from research potentially threatening the ability of practitioners to make independent decisions based on experience and training (Schwalm and Yusuf, 2011). This article examines the rise of evidence based practice and draws out the lessons for contemporary paramedic practice.

In his article ‘The End of Clinical Freedom’ in 1983, JR Hampton examined the role of what is now, over 30 years later, referred to as evidence based practice. In 1983, practitioners were being challenged by the emergence of quality randomised controlled trials (RCTs) (Hampton, 1983) after the disastrous use thalidomide as an antiemetic in the 1960s (Ridings, 2013). This challenged the prevailing practice at the time of relying on experience and training to make treatment decisions. Politics, social issues, and economic factors have been the stimulus for EBP and currently standards of care are being questioned more and more by the patients/clients of healthcare. The media, policy makers and bureaucrats always highlight the cost of treatment and medication as an issue for legislative attention.