research in ems introduction to research steven kanarian, mph, emt-p
TRANSCRIPT
Research in EMSResearch in EMSIntroduction to researchIntroduction to research
Steven Kanarian, MPH, EMT-PSteven Kanarian, MPH, EMT-P
ObjectivesObjectives
Understand research stepsUnderstand research steps Types of researchTypes of research Understand the need for Understand the need for
research in EMSresearch in EMS Role of provider in researchRole of provider in research
What is research?What is research?
Research is learning, seeking the Research is learning, seeking the truthtruth
We learn and gain experience every We learn and gain experience every day.day.
Research is observational or Research is observational or experienceexperience Anecdotal experienceAnecdotal experience Systematic observationSystematic observation Hypothesis testingHypothesis testing
What is evidence based What is evidence based medicine?medicine?
Aims to apply evidence gained Aims to apply evidence gained from the scientific method to from the scientific method to certain parts of medicinecertain parts of medicine Evaluates:Evaluates:
Quality of evidenceQuality of evidence Risk/benefit of treatmentRisk/benefit of treatment
Uses current best evidence to Uses current best evidence to guide careguide care
IOM recommends:IOM recommends:
Separate institute of Separate institute of emergency medicine research emergency medicine research neededneeded The Future of Emergency Care in the US: The Future of Emergency Care in the US:
The Institute of Medicine Subcommittee The Institute of Medicine Subcommittee on Prehospital Emergency Medical on Prehospital Emergency Medical Services, (Ann. Emerg. Med. 2006;48:126-Services, (Ann. Emerg. Med. 2006;48:126-130)130)Challenge for EMS is to measure outcomes.
Types of researchTypes of research
Retrospective – looking backRetrospective – looking back Prospective – designing a study Prospective – designing a study
protocol, collecting data in the protocol, collecting data in the futurefuture
BlindedBlinded RandomizedRandomized Experimental Experimental
Types of researchTypes of research
Retrospective – looking backRetrospective – looking back
Types of researchTypes of research
Prospective – designing a study Prospective – designing a study protocol, collecting data in the protocol, collecting data in the futurefuture
Types of researchTypes of research
BlindedBlinded
Types of researchTypes of research
RandomizedRandomized
Types of researchTypes of research
Experimental Experimental
Literature ReviewLiterature Review
Used to define and explore the Used to define and explore the research topicresearch topic
Literature SearchLiterature Search
Discovers existing researchDiscovers existing research Will help refine questionsWill help refine questions CINAHL, MEDLINE, Science CINAHL, MEDLINE, Science
Direct, PubMedDirect, PubMed Keywords and review articlesKeywords and review articles Note bibliographies and authorsNote bibliographies and authors Search will guide your projectSearch will guide your project
Developing a QuestionDeveloping a Question
Developing the questionDeveloping the question Narrow questionNarrow question Consider past researchConsider past research New trendsNew trends Consults expertsConsults experts
Determining the type of Determining the type of studystudy
ResourcesResources Data availabilityData availability
RegistryRegistry Call report reviewCall report review
Question being askedQuestion being asked StaffingStaffing
Developing the Research Developing the Research ProjectProject
Developing the methodsDeveloping the methods Power calculationPower calculation IRB approvalIRB approval Interacting with providersInteracting with providers Conducting a pilot studyConducting a pilot study Implementing study/analyze Implementing study/analyze
datadata
Reporting the findingsReporting the findings
CME or local conferenceCME or local conference PCRF Forum at JEMSPCRF Forum at JEMS NAEMSP, NAEMSE conferencesNAEMSP, NAEMSE conferences Article or abstract publicationArticle or abstract publication Pre-hospital Emergency Care Pre-hospital Emergency Care
(PEC)(PEC) Annals of Emergency Medicine Annals of Emergency Medicine
(AEM)(AEM)
An Introduction to EMS An Introduction to EMS Research Research
Lawrence H. Brown, Elizabeth Criss, N. Lawrence H. Brown, Elizabeth Criss, N. Heramba PrasadHeramba Prasad
Prentice Hall, Brady publicationsPrentice Hall, Brady publications
Recommended reading….
Reviewing Research Reviewing Research ArticleArticle
Journal/TitleJournal/Title Authors Authors Type of studyType of study Who is doing/paying for studyWho is doing/paying for study MethodsMethods FindingsFindings ConclusionsConclusions
Reading the LiteratureReading the Literature
Critical analysisCritical analysis do the numbers add updo the numbers add up do the numbers make sensedo the numbers make sense do the results answer the questiondo the results answer the question is the data extrapolated too faris the data extrapolated too far
Evaluating An ArticleEvaluating An Article
Evaluate demographicsEvaluate demographics similar system configurationsimilar system configuration similar patient distributionsimilar patient distribution
Evaluate numbersEvaluate numbers enough patientsenough patients right equipmentright equipment comparing apples to apples comparing apples to apples
Reading the LiteratureReading the Literature
Limitations to existing literatureLimitations to existing literature no perfect project no perfect project acknowledge strengths & acknowledge strengths &
weaknessesweaknesses Incorporating into practiceIncorporating into practice
influence current practiceinfluence current practice how much is enoughhow much is enough evidence-based practiceevidence-based practice
Participating in research is importantParticipating in research is important to current practiceto current practice to future practiceto future practice to establishing the professionalism of EMSto establishing the professionalism of EMS
Begin with reading the literatureBegin with reading the literature booksbooks journalsjournals electronic mediaelectronic media
Be critical of researchBe critical of research not all published research is good researchnot all published research is good research not all published research is valuable researchnot all published research is valuable research not all published research is reported correctlynot all published research is reported correctly
Hold people accountableHold people accountable Research is the future of EMSResearch is the future of EMS
validatesvalidates promotespromotes improvesimproves
Let’s take a closer lookLet’s take a closer lookSignificant research in EMSSignificant research in EMS
Research: General Principles and Research: General Principles and Emergency Medicine ApplicationEmergency Medicine Application
John B. McCabe, MD, FACEPJohn B. McCabe, MD, FACEP
Problems with Research in Problems with Research in Emergency MedicineEmergency Medicine
Sporadic patient Sporadic patient loadload
Pre-defined Pre-defined treatmenttreatment
Medical recordsMedical records Multi-institutional Multi-institutional
cooperation may cooperation may be difficultbe difficult
Funding ??Funding ??
What are these???What are these???
MAST PantsMAST Pants
Thought to…..Thought to….. Auto-transfuse 2 units of bloodAuto-transfuse 2 units of blood Increase PVRIncrease PVR Raise BPRaise BP Stabilize pelvic fracturesStabilize pelvic fractures Control surface bleedingControl surface bleeding
Widely used in 1980’s-1990’sWidely used in 1980’s-1990’s
“What happened???”
What happened…What happened… STUDY: Randomized trial of STUDY: Randomized trial of
pneumatic antishock garments in pneumatic antishock garments in the prehospital management of the prehospital management of penetrating abdominal injuries penetrating abdominal injuries
MDWilliam H BickellMDWilliam H Bickell, MDPaul E Pepe, MDPaul E Pepe †, , ‡, , , MDMark , MDMark L BaileyL Bailey, MDCharles H Wyatt, MDCharles H Wyatt and MDKenneth L and MDKenneth L Mattox* Mattox* *Department of Surgery, Baylor College of Medicine, Ben Taub *Department of Surgery, Baylor College of Medicine, Ben Taub General Hospital, Houston, Texas, USAGeneral Hospital, Houston, Texas, USA†Department of Medicine, Baylor College of Medicine, Ben Taub †Department of Medicine, Baylor College of Medicine, Ben Taub General Hospital, Houston, Texas, USAGeneral Hospital, Houston, Texas, USA‡City of Houston Fire Department Emergency Medical Services, ‡City of Houston Fire Department Emergency Medical Services,
Houston, Texas, USAHouston, Texas, USA
Randomized StudyRandomized Study Alternate day randomization (control, Alternate day randomization (control,
N=104, MAST, N = 97)N=104, MAST, N = 97) The results demonstrated no significant The results demonstrated no significant
difference in the survival rates of the difference in the survival rates of the control and PASG treatment groups (81 control and PASG treatment groups (81 of 104 vs 67 of 97).of 104 vs 67 of 97).
“ “ From these data we conclude that, From these data we conclude that, contrary to previous claims, the PASG contrary to previous claims, the PASG provides no significant advantage in provides no significant advantage in improving survival in the urban improving survival in the urban prehospital management of penetrating prehospital management of penetrating abdominal injuries. “abdominal injuries. “
The Ontario Prehospital The Ontario Prehospital Advanced Life Support StudyAdvanced Life Support Study
(OPALS)(OPALS)Ian G Stiell MD, MSc, FRCPC *‡§, George A Wells PhD ‡§, Ian G Stiell MD, MSc, FRCPC *‡§, George A Wells PhD ‡§,
Daniel W Spaite MD ¶IIII, Graham Nichol MD, MPH, FRCPC Daniel W Spaite MD ¶IIII, Graham Nichol MD, MPH, FRCPC #§, Bernard O’Brien PhD**, Douglas P Munkley MD, #§, Bernard O’Brien PhD**, Douglas P Munkley MD,
MCFP(EM)¶, Brian J Field EMA III II, Marion B Lyver MD, MCFP(EM)¶, Brian J Field EMA III II, Marion B Lyver MD, FRCPC, MCFP(EM)#, Lorraine G Luinstra BScN, MHA¶, FRCPC, MCFP(EM)#, Lorraine G Luinstra BScN, MHA¶,
Eugene Dagnone MD, FRCPC‡‡, Tony Campeau BSc§§, Eugene Dagnone MD, FRCPC‡‡, Tony Campeau BSc§§, Roxanne Ward RN§, Steve Anderson BSc§ and For the OPALS Roxanne Ward RN§, Steve Anderson BSc§ and For the OPALS
Study GroupStudy Group
OPALSOPALS
Largest ALS study in the WorldLargest ALS study in the World Will involve 25,000 cardiac Will involve 25,000 cardiac
arrest, trauma and respiratory arrest, trauma and respiratory patientspatients
““Before and after”studyBefore and after”study 8 years of collecting data8 years of collecting data
Outcomes measuredOutcomes measured
Disease Specific Quality of LifeDisease Specific Quality of Life Respiratory Distress and Trauma Respiratory Distress and Trauma
areasareas Process of care measures (rates Process of care measures (rates
of success failure for skills)of success failure for skills) Response timeResponse time Length of stayLength of stay
Unique StudyUnique Study
Before phaseBefore phase Rapid Defib phaseRapid Defib phase ALS phaseALS phase Able to compare the incremental Able to compare the incremental
improvementimprovement
ProvedProved
AED Defibrillation saves livesAED Defibrillation saves lives Medics treat respiratory distress Medics treat respiratory distress
and chest pain effectivelyand chest pain effectively Sets bar for other large scale Sets bar for other large scale
prospective studiesprospective studies
1st responders increase 1st responders increase survivalsurvival
January 1, 1999 to January 31, January 1, 1999 to January 31, 19951995
5,335 Cardiac Arrest Patients5,335 Cardiac Arrest Patients 46.8% witnessed by bystanders46.8% witnessed by bystanders 14.5% received bystander CPR14.5% received bystander CPR 25% received 125% received 1stst responder CPR responder CPR Increased save rate to 3.5 and 8.5% Increased save rate to 3.5 and 8.5%
for VFibfor VFib
Occupational injuries among Occupational injuries among EMS personnelEMS personnel
McGuire, Hunting, Guidotti, Smith McGuire, Hunting, Guidotti, Smith Prehospital Emergency Care 2005;9: 405-411Prehospital Emergency Care 2005;9: 405-411
ObjectiveObjective
Describe the epidemiology of Describe the epidemiology of occupational injuries among occupational injuries among EMS personnel, calculate injury EMS personnel, calculate injury rates, and compare findings with rates, and compare findings with other occupational groups.other occupational groups.
EMS Providers treat 22 million EMS Providers treat 22 million patents per year, little known patents per year, little known about our injuriesabout our injuries
MethodsMethods
Retrospective review of injury records Retrospective review of injury records kept by two urban agencieskept by two urban agencies
617 cases over 3 years617 cases over 3 years Injury rate was 34.6 per 100 employeesInjury rate was 34.6 per 100 employees Most often sprains, strains and tearsMost often sprains, strains and tears Back most frequentBack most frequent 277 cases resulted in lost days from 277 cases resulted in lost days from
workwork
ConclusionsConclusions
Injuries greater for EMS than Injuries greater for EMS than any other industry in 2000 any other industry in 2000 according to DOL statisticsaccording to DOL statistics
Recommended funding and Recommended funding and further research are critical to further research are critical to define problem and prevent define problem and prevent injuriesinjuries
What would you like to What would you like to study??study??
Emerging topicsEmerging topics
Intubation by paramedicsIntubation by paramedics Pain managementPain management EMS Skill retentionEMS Skill retention System designSystem design Clinical interventionsClinical interventions
Where to start?Where to start?
Descriptive study- what are we Descriptive study- what are we doing for our community/school?doing for our community/school?
Where are we making a Where are we making a difference?difference? Pain managementPain management Injury preventionInjury prevention Reduced response timeReduced response time Reduced health care costsReduced health care costs
Research starts with a Research starts with a question and a desire to question and a desire to
learn the truth.learn the truth.
We know EMS makes a We know EMS makes a difference, let’s prove it!!difference, let’s prove it!!
Please leave a Please leave a comment…comment…
Questions about researchQuestions about research How to review an articleHow to review an article