Research in EMS Introduction to research

1. Research in EMSIntroduction to research Steven Kanarian, MPH, EMT-P

2. Objectives • Understand research steps • Types of research • Understand the need for research in EMS • Role of provider in research

3. What is research? • Research is learning, seeking the truth • We learn and gain experience every day. • Research is observational or experience • Anecdotal experience • Systematic observation • Hypothesis testing

4. What is evidence based medicine? • Aims to apply evidence gained from the scientific method to certain parts of medicine • Evaluates: • Quality of evidence • Risk/benefit of treatment • Uses current best evidence to guide care

5. IOM recommends: • Separate institute of emergency medicine research needed • The Future of Emergency Care in the US: The Institute of Medicine Subcommittee on Prehospital Emergency Medical Services, (Ann. Emerg. Med. 2006;48:126-130) Challenge for EMS is to measure outcomes.

6. Types of research • Retrospective – looking back • Prospective – designing a study protocol, collecting data in the future • Blinded • Randomized • Experimental

7. Types of research • Retrospective – looking back

8. Types of research • Prospective – designing a study protocol, collecting data in the future

9. Types of research • Blinded

10. Types of research • Randomized

11. Types of research • Experimental

12. Literature Review Used to define and explore the research topic

13. Literature Search • Discovers existing research • Will help refine questions • CINAHL, MEDLINE, Science Direct, PubMed • Keywords and review articles • Note bibliographies and authors • Search will guide your project

14. Developing a Question • Developing the question • Narrow question • Consider past research • New trends • Consults experts

15. Determining the type of study • Resources • Data availability • Registry • Call report review • Question being asked • Staffing

16. Developing the Research Project • Developing the methods • Power calculation • IRB approval • Interacting with providers • Conducting a pilot study • Implementing study/analyze data

19. Reporting the findings • CME or local conference • PCRF Forum at JEMS • NAEMSP, NAEMSE conferences • Article or abstract publication • Pre-hospital Emergency Care (PEC) • Annals of Emergency Medicine (AEM)

20. Recommended reading…. An Introduction to EMS Research Lawrence H. Brown, Elizabeth Criss, N. Heramba Prasad Prentice Hall, Brady publications

21. Reviewing Research Article • Journal/Title • Authors • Type of study • Who is doing/paying for study • Methods • Findings • Conclusions

22. Reading the Literature • Critical analysis • do the numbers add up • do the numbers make sense • do the results answer the question • is the data extrapolated too far

23. Evaluating An Article • Evaluate demographics • similar system configuration • similar patient distribution • Evaluate numbers • enough patients • right equipment • comparing apples to apples

24. Reading the Literature • Limitations to existing literature • no perfect project • acknowledge strengths & weaknesses • Incorporating into practice • influence current practice • how much is enough • evidence-based practice

25. Participating in research is important • to current practice • to future practice • to establishing the professionalism of EMS • Begin with reading the literature • books • journals • electronic media

26. Be critical of research • not all published research is good research • not all published research is valuable research • not all published research is reported correctly • Hold people accountable • Research is the future of EMS • validates • promotes • improves

27. Let’s take a closer look Significant research in EMS

28. Research: General Principles and Emergency Medicine Application John B. McCabe, MD, FACEP

29. Problems with Research in Emergency Medicine • Sporadic patient load • Pre-defined treatment • Medical records • Multi-institutional cooperation may be difficult • Funding ??

30. What are these???

31. MAST Pants • Thought to….. • Auto-transfuse 2 units of blood • Increase PVR • Raise BP • Stabilize pelvic fractures • Control surface bleeding • Widely used in 1980’s-1990’s “What happened???”

32. What happened… • STUDY: Randomized trial of pneumatic antishock garments in the prehospital management of penetrating abdominal injuries • MDWilliam H Bickell*, MDPaul E Pepe†, ‡, , MDMark L Bailey*, MDCharles H Wyatt* and MDKenneth L Mattox**Department of Surgery, Baylor College of Medicine, Ben Taub General Hospital, Houston, Texas, USA†Department of Medicine, Baylor College of Medicine, Ben Taub General Hospital, Houston, Texas, USA‡City of Houston Fire Department Emergency Medical Services, Houston, Texas, USA

33. Randomized Study • Alternate day randomization (control, N=104, MAST, N = 97) • The results demonstrated no significant difference in the survival rates of the control and PASG treatment groups (81 of 104 vs 67 of 97). • “ From these data we conclude that, contrary to previous claims, the PASG provides no significant advantage in improving survival in the urban prehospital management of penetrating abdominal injuries. “

34. The Ontario Prehospital Advanced Life Support Study(OPALS) Ian G Stiell MD, MSc, FRCPC *‡§, George A Wells PhD ‡§, Daniel W Spaite MD ¶IIII, Graham Nichol MD, MPH, FRCPC #§, Bernard O’Brien PhD**, Douglas P Munkley MD, MCFP(EM)¶, Brian J Field EMA III II, Marion B Lyver MD, FRCPC, MCFP(EM)#, Lorraine G Luinstra BScN, MHA¶, Eugene Dagnone MD, FRCPC‡‡, Tony Campeau BSc§§, Roxanne Ward RN§, Steve Anderson BSc§ and For the OPALS Study Group

35. OPALS • Largest ALS study in the World • Will involve 25,000 cardiac arrest, trauma and respiratory patients • “Before and after”study • 8 years of collecting data

36. Outcomes measured • Disease Specific Quality of Life • Respiratory Distress and Trauma areas • Process of care measures (rates of success failure for skills) • Response time • Length of stay

37. Unique Study • Before phase • Rapid Defib phase • ALS phase • Able to compare the incremental improvement

38. Proved • AED Defibrillation saves lives • Medics treat respiratory distress and chest pain effectively • Sets bar for other large scale prospective studies

39. 1st responders increase survival • January 1, 1999 to January 31, 1995 • 5,335 Cardiac Arrest Patients • 46.8% witnessed by bystanders • 14.5% received bystander CPR • 25% received 1st responder CPR • Increased save rate to 3.5 and 8.5% for VFib

40. Occupational injuries among EMS personnel McGuire, Hunting, Guidotti, Smith Prehospital Emergency Care 2005;9: 405-411

41. Objective • Describe the epidemiology of occupational injuries among EMS personnel, calculate injury rates, and compare findings with other occupational groups. • EMS Providers treat 22 million patents per year, little known about our injuries

42. Methods • Retrospective review of injury records kept by two urban agencies • 617 cases over 3 years • Injury rate was 34.6 per 100 employees • Most often sprains, strains and tears • Back most frequent • 277 cases resulted in lost days from work

43. Conclusions • Injuries greater for EMS than any other industry in 2000 according to DOL statistics • Recommended funding and further research are critical to define problem and prevent injuries

44. What would you like to study??

45. Emerging topics • Intubation by paramedics • Pain management • EMS Skill retention • System design • Clinical interventions

46. Where to start? • Descriptive study- what are we doing for our community/school? • Where are we making a difference? • Pain management • Injury prevention • Reduced response time • Reduced health care costs

47. Research starts with a question and a desire to learn the truth.

48. We know EMS makes a difference, let’s prove it!!

49. Please leave a comment… Questions about research How to review an article