Research in EMS
Introduction to research
Steven Kanarian, MPH, EMT-P
Objectives
 Understand
research steps
 Types of research
 Understand the need for research in
EMS
 Role of provider in research
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
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
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.
Types of research
Retrospective – looking back
 Prospective – designing a study protocol,
collecting data in the future
 Blinded
 Randomized
 Experimental

Types of research

Retrospective – looking back
Types of research

Prospective – designing a study protocol,
collecting data in the future
Types of research

Blinded
Types of research

Randomized
Types of research

Experimental
Literature Review

Used to define and explore the research
topic
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

Developing a Question
Developing the question
 Narrow question
 Consider past research
 New trends
 Consults experts

Determining the type of study
Resources
 Data availability

 Registry
 Call
report review
Question being asked
 Staffing

Developing the Research Project
Developing the methods
 Power calculation
 IRB approval
 Interacting with providers
 Conducting a pilot study
 Implementing study/analyze data

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)

Recommended reading….
An Introduction to EMS
Research
Lawrence H. Brown, Elizabeth Criss, N.
Heramba Prasad
Prentice Hall, Brady publications
Reviewing Research Article
Journal/Title
 Authors
 Type of study
 Who is doing/paying for study
 Methods
 Findings
 Conclusions

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
Evaluating An Article

Evaluate demographics
 similar
system configuration
 similar patient distribution

Evaluate numbers
 enough
patients
 right equipment
 comparing apples to apples
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

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

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

Let’s take a closer look
Significant research in EMS
Research: General Principles and
Emergency Medicine Application
John B. McCabe, MD, FACEP
Problems with Research in
Emergency Medicine





Sporadic patient load
Pre-defined treatment
Medical records
Multi-institutional
cooperation may be
difficult
Funding ??
What are these???
MAST Pants

Thought to…..
 Auto-transfuse
2 units of blood
 Increase
PVR
 Raise BP
“What happened???”
 Stabilize pelvic fractures
 Control surface bleeding

Widely used in 1980’s-1990’s
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
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. “
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
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

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

Unique Study
Before phase
 Rapid Defib phase
 ALS phase
 Able to compare the incremental
improvement

Proved
AED Defibrillation saves lives
 Medics treat respiratory distress and chest
pain effectively
 Sets bar for other large scale prospective
studies

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

Occupational injuries among
EMS personnel
McGuire, Hunting, Guidotti, Smith
Prehospital Emergency Care 2005;9: 405-411
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

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

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

What would you like to
study??
Emerging topics
Intubation by paramedics
 Pain management
 EMS Skill retention
 System design
 Clinical interventions

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
Research starts with a
question and a desire to
learn the truth.
We know EMS makes a
difference, let’s prove it!!
Please leave a comment…
Questions about research
 How to review an article
