Hospital-Based Emergency Care At the Breaking Point (2007) / Chapter Skim
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8 Enhancing the Emergency Care Research Base
8 Enhancing the Emergency Care Research Base
Pages 291-320
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It addresses principally conditions and interventions common to prehospital emergency medical services (EMS) and hospital emergency department (ED)
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A significant focus of trauma research is service delivery and the effectiveness of trauma care systems. The injury control field can be thought of as an arm of trauma research that has developed a distinct or rather several distinct areas of focus.
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A significant amount of the research effort in both emergency and trauma care involves translation of findings from these fields into practice in emergency care settings. There has also been substantial research in emergency care that has flowed back to the specialties.
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In response, the specialty took a number of actions to enhance academic departments and develop the capacity and funding of research in emergency care. In 2003, the American College of Emergency Physicians' (ACEP)
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. Research Training Support Research training grants and fellowships related to emergency care are funded by a number of sources, including institutions, foundations, and federal agencies.
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Further, a notable number of emergency care researchers have obtained support for career development and educational activities through the K08 and K23 mechanisms (ACEP Research Committee, 2005)
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To address the shortage of training for new investigators in emergency medicine, the committee recommends that academic medical centers support emergency and trauma care research by providing research time and adequate facilities for promising emergency care and trauma investigators, and by strongly considering the establishment of autonomous departments of emergency medicine (8.1)
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. The limited amount of funding available for emergency care research extends across a wide range of institutes, programs, and sponsors, although NIH remains the key sponsor.
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In fact, the term "emergency care" does not appear in the NIH Roadmap. Other federal agencies Many other federal agencies provide small amounts of research funding in emergency care.
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identified priority issues for targeted research efforts, including asthma, acute cardiac ischemia, circulatory shock, major injury, pain, acute stroke, and traumatic brain injury, as well as education and system design issues. Critical research questions identified
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0 ENHANCING THE EMERGENCY CARE RESEARCH BASE by these groups cut across basic science, clinical research, and health services research. Some fertile topics for research in each area are described below.
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0 HOSPITAL-BASED EMERGENCY CARE Thus emergency physicians have both the motivation and opportunity for focused efforts aimed at translating research into better modes of treatment. As a result, clinical research represents the most active area of emergency care research.
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0 ENHANCING THE EMERGENCY CARE RESEARCH BASE quality of care and outcomes -- first codified in Crowley's "golden hour" and Pantridge's cardiac care in the field, and reinforced through military and civilian experience. But the organization and delivery of services is perhaps the weakest link in the emergency care evidence base.
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There are a number of examples of successful studies by multicenter research collaborations. The National Emergency X-Radiography Utilization Study (NEXUS)
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The new field of injury science was based on the recognition that patterns of injury could be determined with the epidemiological tools of public health. William Haddon, a public health physician, set forth a scientific paradigm for analyzing injury based on the interaction between human and environmental factors (Haddon, 1968)
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During this period, prehospital EMS became more sophisticated, while at the same time trauma centers and systems were developed and formalized. The American College of Surgeons Committee on Trauma (ACS COT)
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Systematic collection of injury data through such databases as NEISS, the National Trauma Data Bank, the Fatality Analysis Reporting System (FARS) , and state trauma registries is critical to gathering sufficient observations to permit meaningful research.
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. Traumatic injury has surpassed heart disease as the most expensive category of medical treatment, resulting in $71.6 billion dollars in expenditures per year (AHRQ, 2006)
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In addition, there is scant support for the development of investigators in the field. Centers for Disease Control and Preention As noted earlier, the NRC/IOM report Injury in America: A Continuing Public Health Problem (NRC and IOM, 1985)
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In 2005, CDC updated the acute care chapter of the 2002 agenda. This revision identified seven research priorities: • Better translation of findings into patient care through guidelines • Evidence-based protocols • How trauma systems improve care • How mass casualty impacts acute care • Clinical prevention • Psychosocial impact of injury • Development of short- and long-term outcome measures The report also called for enhancing research capacity through four actions: the development of acute care injury research networks; the conduct of research by mining current and future databases; the development of new investigators though training grants; and reductions in institutional barriers to research, such as Emergency Medical Treatment and Active Labor Act
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. Congress and federal agencies involved in emergency and trauma care research (including the Department of Transportation, the Department of Health and Human Services, the Department of Homeland Security, and the Department of Defense)
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These perspectives can be particularly valuable for judging proposals that require the timely recruitment of research subjects in acute care situations and for addressing the logistical challenges of conducting well-controlled clinical research in EDs, trauma centers, and other acute care environments. General Clinical Research Centers (GCRCs)
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within the Department of Health and Human Services is the agency assigned to enforce protections for human subjects. The rules attempt to balance the value of important research against the potential harm to patients resulting from that research.
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. the logistical application of these ethical standards across institutions or among different research studies remains complex and variable." Furthermore, state regulations occasionally preempt the federal exception for emergency care research.
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8.2b: Congress and federal agencies involved in emergency and trauma care research (including the Department of Trans portation, the Department of Health and Human Services, the Department of Homeland Security, and the Department of Defense) should implement the study's recommendations.
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2005. National Trauma Data Bank Report 00, Dataset Version .0.
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Consensus statement from the coalition conference of acute resuscitation and critical care researchers. Journal of the American Medical Association 273(16)
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1999. Emergency Medical Services Outcomes Project I (EMSOP I)
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:1247–1258. NHTSA (National Highway Traffic Safety Administration)
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1981. Regionalization of trauma care.
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