Research and EMS

1. 1 Research and EMS

2. Introduction • In EMS we spend nearly 3 billion dollars each year delivering care, but little of what we do has truly been evaluated. • How do we know we are being helpful? • How do we know that the tools we use are effective?

3. Research guides the care we provide.

4. Evidence-Based Approach • Outcomes of therapies and interventions are carefully measured to ensure the intended results. • When changes are made, decisions are based on clear indications and outcomes.

5. Evidence-Based Approach (cont’d) • Quality research and the evidence based approach allows the EMS profession to: • Answer questions • Expand resources wisely • Avoid spending time and money on ineffective therapies • Focus budgets on elements that mean the most to patient care

6. Prospective vs. Retrospective • Prospective research method • Designed to look forward and test therapies/outcomes in the future. • Easier to control errors and prevent bias.

7. Prospective vs. Retrospective (cont’d) • Retrospective research method • Looks at events that have occurred in the past, evaluating the outcome of therapies previously performed. • Difficult to control and less valid.

8. Randomization • The research study compares one therapy against another by randomly assigning a specific therapy to patients as opposed to having predetermined groups • Bias is controlled • Improves objectivity • Utilizes blinding to improve objectivity

9. Blinding • Keeps the patient from knowing which therapy they are receiving. • Makes it very difficult to influence outcomes thus improving objectivity. • Single blind: the researcher knows who is getting what therapy • Double blind: neither the patient nor the researcher knows who is getting what therapy

10. Control Groups • In medicine, a control group is commonly a known, or currently used therapy. • Helps to better evaluate outcomes fairly. • Comparison adds weight and value to the analysis.

11. Level of Evidence • The American Heart Association qualifies the validity of research in a linear fashion. • Assigns varying levels of importance based on the way studies are conducted. • Useful in evaluating the importance of data.

12. Level of Evidence (cont’d) • Can be used as a framework for considering the utility of a particular study.

13. Level of Evidence (cont’d) • Level of Evidence 1 – The most valuable set of data results from randomized control trials or meta-analyses of RCTs. • Level of Evidence 2 – Studies using concurrent controls without true randomization. • Level of Evidence 3 – Studies using retrospective controls.

14. Level of Evidence (cont’d) • Level of Evidence 4 – Studies without a control group. • Level of Evidence 5 – Studies not directly related to the specific patient or population.

15. Reviewing Research • Was the study randomized? • Was the randomization blinded? • If more than one group, were the groups similar at the start of the trial? • Were all eligible patients analyzed? • If they were excluded, why? • Were the outcomes a result of the therapy? • Is the outcome relevant?

16. Read and evaluate research

17. You and EMS Research • As an ALS provider of the future, you will be on the front line of conducting research. • Strong documentation will help improve future studies. • Your service, local hospital, or region may participate and enroll patients in a specifically-designed experiment. • You may take part in designing a study.

18. Summary • EMS research is an important part of the future of our profession. • It is imperative to understand the basic concepts of research as well as know how to read and evaluate research literature. • Being involved in research development offers a rewarding pathway for enlightened providers.