Emergency Medical Services At the Crossroads (2007) / Chapter Skim
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7 Optimizing Prehospital Care Through Research
7 Optimizing Prehospital Care Through Research
Pages 207-230
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Trauma care research is a parallel field of study that is also defined by time and place. Trauma care deals principally with the acute management of patients with traumatic injuries.
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, affiliated with the American College of Emergency Physicians (ACEP) , and the Society for Academic Emergency Medicine (SAEM)
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centers of excellence should be created to facilitate EMS research; (3) federal agencies should commit to supporting EMS research; (4)
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The move to electronic data collection and more passive forms of data gathering might help alleviate this problem. Even before the enactment of the Health Insurance Portability and Accountability Act (HIPAA; see below)
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While this problem is not unique to EMS, it presents a significant barrier to ensuring that patients receive prehospital medical services that are supported by a strong evidence base. Accordingly, the National EMS Research Agenda recommended that "EMS professionals of all levels should hold themselves to higher standards of requiring evidence before implementing new procedures, devices, or drugs" (NHTSA, 2001a; Sayre et al., 2002)
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. Moreover, patients treated in the emergency and trauma care setting frequently suffer acute, debilitating illnesses or injuries that affect their capacity to make informed deci
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within the Department of Health and Human Services (DHHS) , and a research organization.
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. None of the current Institutes or Centers are defined either by the site of care or the timing or urgency of care, which are the defining characteristics of emergency and trauma care research.
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. National Highway Traffic Safety Administration The Office of EMS within NHTSA plays a lead role in coordinating activities related to EMS system development and research.
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Health Resources and Serices Administration The Emergency Medical Services for Children (EMS-C) program, jointly funded by HRSA and NHTSA, is one of the largest grant programs supporting EMS research.
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CDC's recently completed Acute Injury Care Research Agenda (CDC, 2005) was developed with extensive input from academic research centers, national nonprofit organizations, and other federal agencies with a stake in injury prevention.
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regions. The primary objective of the study was to determine whether the use of AEDs by response teams composed of volunteer laypersons who were also trained in cardiopulmonary resuscitation (CPR)
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. The project involved the training of over 2,500 paramedics from 56 different EMS agencies in Los Angeles and Orange Counties, as well as 500 paramedic students.
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The committee recommends that federal agencies that fund emergency and trauma care research target additional funding at prehospital emergency medical services research, with an emphasis on systems and outcomes
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Expanding the Role of Emergency and Trauma Care Researchers in the Grant Review Process One of the greatest impediments to grant funding for emergency and trauma care research at NIH and other agencies is the dearth of researchers in the field involved in developing intramural and extramural research strategies and serving on grant review panels. This is due in part to the crosscutting nature of the discipline, the relative youth of the field, and the small number of mature investigators.
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This involvement should encompass any areas of research -- including basic, clinical, and systems research -- that could have significant application to emergency and trauma care settings, including prehospital, hospital-based emergency, and trauma care. Removing Regulatory Barriers As described above, conducting research in the out-of-hospital environment is unusually challenging.
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The committee therefore believes that Congress and state governments should amend patient confidentiality regulations to allow, under strictly defined circumstances, outof-hospital and ED records to be linked with longitudinal data on patient outcomes. A working group should be established to consider the specific changes required to address the dampening effect of these regulations on emergency and trauma care research while maintaining their original patient protection goals.
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This study should include consideration of the training of new investigators, the development of multicenter research networks, the involvement of emergency medical services researchers in the grant review and research advisory processes, and improved research coordination through a dedicated center or institute. 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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Systems Research • Impact of level of training (e.g., EMT-Basic, EMT-Paramedic) on condition upon arrival and long-term outcome • Cost and effectiveness of EMS systems, in particular how they are impacted by the characteristics of the system • Time interval modeling identifying what changes outcomes, and when and where, in the prehospital setting • Cost-effectiveness of procedures needed for a range of conditions in a range of settings, including nonemergent care • Safety and impact of routing nonemergency 9-1-1 calls to nurse advice lines • Safety and impact of treat and release policies versus EMS transport • Impact of medical direction on the performance of EMS systems • Effectiveness of EMS with respect to injury and acute disease • Incremental value of advanced life support over basic techniques in trauma care • Effectiveness of new communication techniques (e.g., streaming video)
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From page 226... ...
This study should include consideration of the training of new investigators, the development of multicenter research networks, the involvement of emergency medical services researchers in the grant review and research advisory processes, and improved research coordination through a dedicated center or institute. 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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2003. Can first responders be sent to selected 9-1-1 emergency medical services calls without an ambulance?
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:1426–1429. NHTSA (National Highway Traffic Safety Administration)
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1995. Emergency medical service systems research: Problems of the past, challenges of the future.
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