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BACKGROUND - HOW WERE 
THE BEST PRACTICES DEVELOPED?

George Velianoff, RN, DNS, Chief Operating Officer, Emergency Nurses Association; 
Jeffrey W. Runge, MD, Assistant Chair, Emergency Medicine and Director 
Carolinas Center for Injury Control, Carolinas Medical Center; 
Valerie A. Gompf, Highway Safety Specialist, Impaired Driving Division, 
National Highway Traffic Safety Administration

In August 1998, the National Highway Traffic Safety Administration (NHTSA) met with representatives from the American College of Emergency Physicians and the Emergency Nurses Association to discuss Partners in Progress: An Impaired Driving Guide for Action and specifically to plan, organize and conduct a national conference on Strategy III (Health Care Community). The purpose was to re-energize healthcare providers’ involvement in reaching the national goal of reducing alcohol-related driving fatalities in America to no more than 11,000 by the year 2005. The objectives of the conference were to build a strong advocacy base, provide knowledge in state-of-the-art interventions, address obstacles and limitations, and present models of success.

During the conference planning meeting held on January 7, 2000, discussion centered on the best format and outcome of a national conference. It was decided that the conference should produce a product, namely a Best Practice Standard of Care. It was suggested that case studies of system failures and successes should be presented, as well as research and disease models, public health models and validated tools for use in the emergency care environment for assessing impaired driving behavior. In addition, a method of education and referral of patients should be addressed. To develop Best Practices, a "strawman" was proposed as a way to structure the Best Practice Standards with three natural categories: Pre-Hospital Professionals (EMT, Paramedic, Flight, Fire, and First Medical responder), Physicians, and Nurses. A preliminary Best Practice Standard for each category was developed as a starting point for the conference discussion and breakouts. In addition, Policy Issues for Administrators were also identified and included in the Standards.

The planning group identified a large number of national organizations to receive invitations to the conference. These organizations included:

Each organization was encouraged to send three members to the conference. The conference agenda was sent to each organization, related association journals and other targeted individuals. For a list of conference attendees, see Appendix B.

The planning committee developed the conference agenda and identified speakers and panel members for the break-out groups. The speakers’ role was to present the conference goals and the latest research available on this issue. The panel members listened to the facilitated break-out sessions to help revise the Best Practices for each group (physicians, nurses and pre-hospital professionals). One of the major outcomes of the conference was the consensus to change the Best Practice Standards to Best Practices. The attendees felt strongly that this group was not yet prepared to recommend Standards based on the current research, and that Best Practices was the more appropriate term. The end product of the conference was the development of Best Practices of Emergency Medical Care for the Alcohol-Impaired Patient.