EBM in practice: emergency medicine

Multiple, synchronous and interdependent management questions in emergency medicine make it difficult to apply evidence-based medicine (EBM), which mostly focuses on single interventions. Emergency medicine is part of a system of care; EBM has limited utility in systems evaluation. There is a dearth of published evidence of specific relevance to emergency medicine. Because of practical difficulties with "real time" application of EBM in emergency medicine, methods have been adopted for incorporating evidence into practice in anticipation of clinical situations. Emergency medicine must improve its evidence base and develop methods suitable for evaluating systems of care.