Lawrence Brown on EMS Research
“10 Minutes With” is a bimonthly column that presents brief interviews with leaders involved in many facets of emergency medical services. Suggestions for topics can be sent to the author at rbarishansky@onebox.com.
Research in EMS is one component of the system that has been sorely lacking. Treatment modalities and equipment have more often been proposed and implemented on the basis of anecdotal recollections than on multiple, statistically sound, peer-reviewed research studies. Only in the last few years have studies on even the most common prehospital practices and interventions occurred. Equally important to these first attempts at objectively assessing EMS operations is the formal development of the National Highway Traffic Safety Administration’s (NHTSA) National EMS Research Agenda.
The use of treatment modalities and equipment that are predicated upon valid research studies is one of the primary elements that will help EMS evolve from a “we’ve always done it this way” field to a respected, evidence-based facet of the healthcare system.
For this month’s column, I spoke with Lawrence H. Brown, EMT-P, clinical assistant professor and director of research for the Department of Emergency Medicine, State University of New York (SUNY) Upstate Medical University in Syracuse, and one of EMS’s preeminent researchers. Brown is a co-investigator for NHTSA’s National EMS Research Agenda and also participated in the first series of EMS-Public Health roundtable discussions. He is widely recognized for his involvement in landmark EMS research, including a recently published scientific study that examined the temperatures of medications stored in ambulances around the United States.
What can street-level EMS providers do to advance EMS research?
In the end, it’s the research that has an impact on street-level EMS that will make the difference—whether it’s research about a clinical intervention, about how EMS providers are educated, or about how EMS systems are structured. EMS professionals can advance EMS research, first and foremost, by demanding that their interventions are research-based. New treatments or policies should be evaluated before they are implemented, and existing interventions and activities shouldn’t be assumed to be appropriate unless, or until, they are subjected to scientific evaluation.
Second, they need to commit to using the results of that research. EMS professionals must be open to changing their practices or to adopting new practices if scientific evidence indicates it. Sometimes that means putting aside long-held beliefs about what EMS is and does.
Also, not every EMS provider needs to be a researcher, but we do all need to be supportive of the process. Field EMS studies cannot be done without cooperation from street-level providers who are willing to follow the research protocols and enroll patients. Efforts to increase EMS provider demand for, utilization of and participation in EMS research are an integral part of the National EMS Research Agenda.
What are the most important attributes that an EMS research study needs to have?
EMS research isn’t different from any other kind of research. Studies must address meaningful research questions, the answers to which may actually change practice. Studies need to be well-designed, use accepted and proven scientific methodologies, and include rigorous statistical analysis. Like all good research, EMS studies need to be objective. Sometimes that can be the hardest part, but EMS researchers have to be open to finding out that the answer to their research question might be completely different than what they thought it would be.
What studies are you currently working on and what impact do you see these having on the EMS system?
I’ve been privileged to participate in a nationwide effort, led by the American Ambulance Association and the United States Pharmacopeial Convention (USP), to gain a better understanding of the environmental issues concerning EMS medication storage. This is the first time the EMS industry, EMS researchers and the USP have worked together to evaluate the problems and propose solutions. There’s still much more work to be done in this area, but in the long run, the result will be evidence-based regulations regarding EMS medication storage, as well as scientifically proven solutions to the problems of medication exposure to excessive heat and excessive cold. Both temperature extremes, it turns out, are a problem pretty much everywhere.
Also, through my work with the Public Access Defibrillation (PAD) Trial and the National EMS Research Agenda, I’ve been engaged in the issues surrounding the difficulty of obtaining informed consent for research in emergency situations. That will be the focus of an upcoming phase of the agenda project. One result of that work should be that EMS researchers gain a better understanding of the principles and regulations concerning consent for research, and that research regulators—especially institutional review board (IRB) members—gain a better understanding of the realities of the EMS environment. With a better understanding of each other’s perspectives, EMS researchers and research regulators should be better able to craft creative and ethical approaches to consent in emergency situations.
What is the role of a trade journal such as EMS Magazine in regard to significant research studies that will impact the EMS system, as opposed to the role of a strictly academic journal like the Annals of Emergency Medicine?
Trade journals play an important role in disseminating research findings to EMS professionals. They will never be the primary venue for publication of research results, but they can and should report on research that has been published in the peer-reviewed scientific literature. They can also report on best practices that are developed by leading EMS systems, and emphasize the role of research in developing and evaluating them.
Additionally, the clinical articles that appear in trade publications can be forward-looking, presenting cutting-edge concepts. These will generate new ideas and can become the basis for new research questions.
Do you see an undergraduate or graduate-level degree being a necessity for an EMS researcher?
Formal research training isn’t an absolute necessity for someone interested in research. Just as there are physicians and nurses without advanced research training who become clinician-researchers, so can EMS providers. Having said that, there is a need for EMS researchers who do have formal research training. Clinician-researchers play an important role in EMS research, but they cannot do it alone. Indeed, developing a cadre of trained researchers is another one of the goals of the National EMS Research Agenda. EMS professionals who intend to pursue a career in research should obtain advanced education in research methods. To that end, the National Registry of Emergency Medical Technicians (NREMT) has established a Research Fellowship, through which they will facilitate an EMS professional in obtaining a doctorate-level degree in research methods. The NREMT should be applauded for this display of leadership. Research training, however, doesn’t have to be specific to EMS. All master’s-level and doctorate-level programs in research methods teach research skills, independent of the program area or focus, that are translatable to all kinds of research.
For a free copy of NHTSA’s EMS Research Agenda for the Future, go to www.nhtsa.dot.gov/people/injury/ems/EMS03-ResearchAgenda/home.htm. This year’s NREMT Research Fellowship filing period closed May 1, 2004. For information on future opportunities, send a cover letter and resume to Gregg Margolis, Associate Director, NREMT, P.O. Box 29233, Columbus, OH 43299.
