There are two primary barriers that
have inhibited the development of a strong research program in EMS.
They are a paucity of well-trained researchers with an interest in
EMS research and a lack of reliable funding sources to support research.
There are also three identifiable secondary barriers to EMS research.
They are: a lack of recognizing the need for evidence-based practice;
standardizing, accessing and sharing data; and complying with the
current established ethical requirements for human research.
To some extent, there is a chicken
and egg phenomenon at work within the two primary barriers to developing
a comprehensive EMS research program. For example, funding agencies
understandably prefer to place their funds with researchers who have
a track record of proven productivity. However, since there are not
many proven researchers with interests in EMS problems, few funds
flow into EMS-related research. On the other hand, academic institutions
are reluctant to support the professional development of new, EMS-focused
researchers because they cannot identify likely funding sources with
a history of supporting EMS research.
As a discipline of medicine, EMS needs
to develop a larger cadre of experienced investigators. Novice investigators
need formal research training and the opportunity to work with experienced
mentors. EMS researchers must collaborate with social scientists,
economists, health services researchers, epidemiologists, operations
researchers, and other clinical scientists to increase the expertise
available for, to generate novel hypotheses in, and to improve the
quality of investigations.
Researchers affiliated with medical
schools and large teaching hospitals perform most EMS studies because
those institutions have the necessary research infrastructure. They
offer Institutional Review Board review as well as assistance with
obtaining grants and negotiating contracts. They have large libraries
with many resources. Statisticians, epidemiologists, methodologists,
database managers, and software engineers are available for consultation.
Emergency physicians, cardiologists, surgeons, pediatricians, and
other specialists who have interests in specific areas of EMS are
available for collaboration. Opportunities exist for EMS researchers
to collaborate with other disciplines and with industry in many different
areas of scientific evaluation. Public health initiatives, injury
prevention, development of new technologies, and health economics
are examples of areas in which such opportunities exist. Prospective
EMS researchers who do not have easy access to the traditional academic
research setting may be able to establish relationships with public
agencies or private corporations and build their research careers
through those venues.
Most EMS researchers have little or
no formal training in research methodology.
Many colleges and universities have programs that could provide training
to interested EMS professionals. For example, graduate degree programs
in research and public health are widely available and could easily be
tailored to meet the needs of students with specific EMS interests. One
good model of such training programs is the Robert Wood Johnson Foundation
Clinical Scholars Program. There are examples of successful collaboration
between academic institutions and EMS agencies to provide EMS fellowship
training to interested physicians. The Society for Academic Emergency Medicine
and the Medtronic Physio-Control Corporation have supported an EMS fellowship
program since 1990, and most graduates of that program have pursued careers
in EMS research. Still, these training opportunities are limited in their
A large cadre of career
EMS investigators should be developed and supported in the initial
stages of their careers. Highly structured training programs
with content directed toward EMS research methodologies should
Fellowship training programs
capable of producing at least five EMS researchers per year are needed.
Federal agencies are potential funding sources for these fellowships.
Ideally, fellowship programs should be at least two years in length
and should produce individuals with training and expertise in both
research methods and funding acquisition. A doctoral degree (PhD,
MD, etc.) should be a prerequisite for entry into the training programs.
Program funding that includes institutional overhead and provides
funds to ensure that research projects can be accomplished during
the fellowship is essential. Individual training grants specifically
targeted to EMS specific topics and system evaluation should be available.
Strong consideration should also be
given to developing a few centers of excellence in EMS related research.
These centers would use their financial resources to build the necessary
infrastructure to successfully complete EMS related research. That
infrastructure would necessarily include experienced investigators,
information systems support, strong links with the local and regional
EMS providers, and training opportunities for novice investigators.
Protected time for faculty engaged
in research is not adequate in most academic Departments of Emergency
Medicine and degree granting institutions offering EMS provider education.
Protected time is necessary to ensure research productivity. Developing
faculty requires making an investment in them. Academic departments
need to invest in EMS research by supporting adequate release time
for researchers, and senior faculty should invest in EMS research
by serving as mentors to novice researchers. EMS centers of excellence
would provide support for release time to permit faculty to engage
Several important EMS problems have
a relatively low frequency of events. This is true for clinical,
systems and education issues. These questions will need to be addressed
using a multi-center collaborative approach. While a number of such
trials have been completed in recent years, these efforts need to
It would be useful to develop one or more EMS research coordinating centers
to pull together the resources necessary to organize and manage multi-center
of Excellence should be created to facilitate EMS research. These
Centers will bring together experienced investigators, institutional
expertise, and resources such as budgetary and information systems
support. Centers will develop and maintain strong working relationships
with local and regional EMS providers. As the focal point of these
resources, Centers of Excellence will be the catalyst for collaboration
between EMS systems and investigators. Such an environment will
enable quality research to flourish.
One or more federal agencies should encourage the submission of proposals
to develop at least five EMS Centers of Excellence. Each successful applicant
should be funded for five years and be evaluated for renewal in a competitive
application process. At least $1M should be devoted to development of research
programs and infrastructure at each Center every year. Each Center should
be located within an academic institution with ties to fellowship programs,
career faculty researchers, multidisciplinary expertise, training programs,
and other resources necessary to create research infrastructure.
One or more federal agencies should issue requests for proposals for at
least two regional EMS research centers. The centers will organize and
manage multi-system studies. The centers will form a network to facilitate
access to data. Each center should operate on a five-year funding cycle
with a competitive renewal process at the end of each five-year phase.
As a unique body of knowledge is developed,
EMS will become recognized as a medical subspecialty. Credentialing
within the subspecialty will carry with it an obligation to advance
the knowledge base of EMS. An increasing numbers of researchers will
be drawn into the field, and academic institutions will develop the
necessary infrastructure to support their activities. The resultant
interactions between faculty, colleagues, fellows, and students will
create a milieu resulting in an increased number of people with excellent
EMS research skills. As these academic programs develop they will
attract new researchers who will want to obtain advanced training
and advanced degrees in research. The research produced by these
well-trained EMS researchers will contribute to the continued growth
of the subspecialty.