National EMS Research Agenda
 

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Index

Abstract

Dedication

Preface

Definition of EMS for this Document

Federal Agencies Can Help Advance EMS Research

Executive Summary

Introduction

History of EMS Research

The Present State of EMS Research

Overcoming the Barriers to EMS Research

ArrowPrimary Barriers: Funding

ArrowSecondary Barriers: Recognizing the Need for EMS Research

ArrowThe Public and Policy Makers

ArrowHardware & Software Infrastructure

ArrowInformed Consent

Appendix

References

Overcoming The Barriers to EMS Research

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.

Primary Barriers: Developing Researchers

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. 1 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 availability.

Recommendation 1.

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 be developed.

·         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 in research.

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 be expanded. 81 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 clinical trials.

Recommendation 2.

Centers 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.