The CoSTR
National guidelines for first aid
The recommendations cited below come from studies conducted by ILCOR.
The recommendations we present here comprehensively summarize the decisions arising from multiple scientific publications on a national scale. These recommendations present the most recent evidence on first aid, reviewed by the scientific experts of the working group of the International Liaison Committee on Resuscitation (ILCOR). They were designed based on reliable scientific research that makes it possible to define clear guidelines on the training and practical application of first aid.
The keys to the guideline development process
___________________________
ILCOR is a committee created in 1992 to serve as a liaison forum among the world’s leading resuscitation organizations. Its mission is to develop, with the help of its members, guidelines on resuscitation and first aid. It plays a crucial role in the evaluation, discussion, and debate of the thousands of peer-reviewed publications (ILCOR, n.d.).
To issue its recommendations, ILCOR forms working groups made up of hundreds of researchers and experts who are tasked with identifying and evaluating the evidence on specific topics. The first aid working group is responsible for coordinating international efforts in first aid. It establishes objectives for first aid practice, produces an international definition of first aid, and collaborates on the development of treatment recommendations. When developing the guidelines, the working group members evaluate data from thousands of scientific works and address issues to consider in collaboration with first aid professionals.
To enable continuous evaluation of the evidence, ILCOR calls on experts to analyze the existing evidence relating to the priority topics selected by the first aid working group and to carry out meta-analyses and syntheses of the scientific data. The data gathered from the systematic evaluation of each priority topic are then analyzed by the working group members and compiled into a Consensus on Science with Treatment Recommendations (CoSTR) document.
The preliminary document of the CoSTR statements is first made available to the public to gather comments. The writing groups of the ILCOR working group then compose the final recommendations, presented in the CoSTR summary, taking into account the comments received. The official CoSTR summary is then used to define the guidelines for the training and practical application of first aid.
PICOST: Population, Intervention, Comparator, Outcome, Study design, Time frame.
The PICOST framework is used to structure the analysis of evidence and recommendations. It defines the key characteristics of the studies and evidence taken into account in the development of the guidelines.
In order to examine, classify, and prioritize the data collected, the CoSTR working groups use the PICOST framework to formulate questions that take into account the populations concerned, the interventions performed, the comparators in similar circumstances, the outcomes for each patient, the methodology used, and the duration of the research. First aid recommendations are issued according to the most positive outcomes possible.
Summary of the guideline development process
___________________________
The composition of the guidelines results from a process of evaluation, discussion, and deliberation on the certainty of the data. The ILCOR first aid working group carries out this process by relying on criteria for classifying recommendations, analyzing data, development, and evaluation. It then presents its consensus on the treatment recommendations by setting out the main factual data and identifying the priority knowledge gaps for future research.
The types of data evaluation
The development of first aid guidelines is based on three types of evidence evaluation: the systematic review, the scoping review, and the evidence update (M. E. Singletary et al., 2020).
The systematic review: This is a process of synthesizing the literature based on a search and selection of targeted topics, an assessment of the quality of the studies, and a transparent presentation of the results. In developing first aid recommendations, the specific questions to be studied are formulated according to the PICOST framework. Each element to be studied is determined by a knowledge synthesis unit, an expert systematic reviewer, or by the working group, and classified according to its importance. The systematic reviews are then published separately.
The scoping review: This second major type of evaluation is designed to identify and catalogue the available evidence. It therefore serves to identify the extent, range, and nature of the data on a topic or question. This review can then lead to a systematic review. In the recommendation development process, the working group analyzes the identified data and determines its value and its implications for practice or research in the field of first aid. If the scoping review did not identify evidence justifying a systematic review, the most recent recommendations are reiterated.
The evidence update: This type of evaluation is performed to identify studies published after the last evaluation of the evidence in order to update the previous systematic reviews. This evidence update is carried out by members of the first aid working group, collaborating experts, or members of the writing groups.
Transparency and conflict-of-interest policies
ILCOR’s evidence evaluation process, as well as the development of guidelines by the main bodies, is governed by strict disclosure policies. These policies are intended to ensure that ILCOR manages situations of actual and potential conflicts of interest in a transparent and effective manner, in order to preserve public trust in the integrity of its process and its documents (ILCOR, 2017, article 8). Thus, the relevant relationships are disclosed in the update of the recommendations published in 2020, as well as in all CoSTR publications.
___________________________
Formation RCR et Secourisme Québec is committed to offering high-quality training in compliance with these guidelines, ensuring that our first aid programs are based on rigorous scientific evidence and reflect the international consensus on first aid practice. We are committed to passing on to our members reliable knowledge based on the most recent recommendations in order to guarantee best practices in emergency care. In short, our commitment to following the recommendations presented in the CoSTR summary ensures the quality and relevance of our training.
Guidelines - CPR
ILCOR. n.d. “About: International Liaison Committee on Resuscitation.” https://ilcor.org/about
ILCOR. 2017. “Internal rules.” https://www.ilcor.org/data/InternalRulesNovember2017.pdf
Singletary, E. M., Zideman, D. A., Bendall, J. C., Berry, D. C., Borra, V., Carlson, J. N., Cassan, P., Chang, W.-T., Charlton, N. P., Djärv, T., Douma, M. J., Epstein, J. L., Hood, N. A., Markenson, D. S., Meyran, D., Orkin, A. M., Sakamoto, T., Swain, J. M. and Woodin, J. A. 2020. “2020 International Consensus on First Aid Science With Treatment Recommendations.” Circulation. Vol. 142, no. 16, suppl. 1, S284-S334. https://doi.org/10.1161/CIR.0000000000000897
Guidelines - First aid with treatment recommendations