999 EMS Research Forum
Prioritisation of topics for research
in prehospital care
999emsrf@swansea.ac.uk
• The 999 EMS Research Forum is a
partnership of academics, clinicians,
prehospital care practitioners and
managers, formed in 1999, whose aim is
to encourage, promote and disseminate
research and evidence based policy and
practice in 999 healthcare.
999emsrf@swansea.ac.uk
Review of research in
prehospital care for DH
• Objectives
– identify and review reviews
– identify the limitations and strengths of existing prehospital care evidence
– identify ongoing research and planned delivery of
results
– match existing research evidence with current policy
developments to identify gaps
– identify priority areas for further research, with
associated timescales and type of research required
999emsrf@swansea.ac.uk
Sources of policy
documents & guidelines:
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Emergency Care policy documents published by the Dept. of Health
at:
http://www.dh.gov.uk/en/Policyandguidance/Organisationpolicy/Emerg
encycare/index.htm
Cochrane Prehospital and Emergency Health Field Website
NHS National Library for Health Emergency Care Specialist Library
Emergency Care web pages at the Health Services Research Institute
of Warwick University
Service Delivery Organisation webpages at http://www.sdo.lshtm.ac.uk
National Institute for Clinical Excellence guidance
National Service Frameworks
References of policy documents obtained
Joint Royal Colleges Ambulance Liaison Committee (JRCALC) website
(key points related to treatment included)
999emsrf@swansea.ac.uk
Sources of prehospital
research literature:
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PubMed
Web of Science
The Cochrane Library
HMIC (Health Management Information Consortium)
DUETs (Database of Uncertainties about the Effects of
Treatment)
• The National Research Register
• HTA research publications list
• Ongoing and recently completed research listed on the
HTA, SDO and Cochrane Library websites
999emsrf@swansea.ac.uk
Drafting of list for
prioritisation
• Table of policy matched to evidence
• Gaps highlighted
• Combined with list of topics of research from
Ambex 2006 conference session
• Circulated to wide group to identify omissions
(done)
• Further circulation (two stages) planned to
achieve ranking of:
– Topic areas
– questions
999emsrf@swansea.ac.uk
Topic area examples
• Access – call handling and despatch
• Rise in demand
• Pre-999 call
• Emergency call management
• Access – 999 emergency response
• Management and operations
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Organisation of EMS
Workforce
Service users
Information
• Services - Alternatives to ambulance/A&E
• Direct referral to specialist care
• Management outside A&E
• Helicopters
• Treatments - Clinical interventions
• Children, trauma, airways, diabetes, stroke, chest pain, pain, seizures,
nausea
Questions
Rise in demand
• Understanding the causes of the rise in demand for
emergency calls
• epidemiology of the rise in demand for emergency calls
• developing interventions to manage the increase
• Understanding how services are being used and
variations and inequalities in access, service user
decision making
• Effects of publicity campaigns for appropriate use of 999
service
999emsrf@swansea.ac.uk
Questions
Workforce
• Skills and competencies in the EMS workforce
• Training of paramedics in primary care skills
• PTSD in ambulance personnel: prevalence and
effectiveness of interventions
• workforce safety - hazards in community
response
999emsrf@swansea.ac.uk
Questions
Trauma management
• MAST suit for subgroups of patients
• Investigation into variations in the treatment and
management of ankle fractures
• Use of spinal boards (Literature review)
• Airway management
• Intravenous fluid administration
999emsrf@swansea.ac.uk
Delphi circulation list
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British Paramedic Association Research Committee
JRCALC Committee
Ambulance service medical/clinical directors (DOCCs)
Ambulance service R&D leads
International representatives from Europe and USA
Ambulance service trust chief executive
Operations director of an ambulance service trust
Faculty of Prehospital Care Research Committee
INVOLVE and/or the Patients’ Forum
College of Emergency Medicine
BASICS the British Association for Immediate Care
Royal College of GPs
999 EMS Research Forum Board
Thematic Research network for emergency and UnScheduled
Treatment (TRUST) Board members
If you want to be included contact:
999emsrf@swansea.ac.uk
Method
• Delphi exercise with 2 rounds
• Every stakeholder asked to score
questions AND topics
• Score 1 not important to 9 most important
• Questions and topics ranked by scores
• Re-circulated and re-scored
What’s important?
What’s important?
• Related to VoI
• Based on
– Burden of disease
• Size of patient group
• Severity of condition
– Uncertainty about best care, etc
• No evidence, weak evidence, etc
– Potential (therapeutic) impact
• Size of possible effect
– Cost
Dissemination
• DH
• Publication
• Use to help funding bodies decide on
priorities
New funding opportunities
- CSR uplift to £1.7Bn
- New programmes in translational medicine, public
health, methods, e-health
- substantial expansion for HTA, SDO, etc