Although things are improving, many„EMS practices remain unsupported by research. Benefits to support„EMS research include providing a new career path for employees, building a rapport with the medical community, improving community ties, creating a positive image and — most importantly — ensuring optimal patient care. The only way for research to be conducted in the real-world prehospital setting is for„EMS systems to support and participate in research. Few„EMS administrators, managers or supervisors doubt the importance of research, but most don’t think of themselves as„”researchers”and many aren’t sure what role they can or should play in the process. This article outlines some of things„EMS administrators, managers and supervisors can do to support research.
According to the„Institute of„Medicine, successful research environments require seven things: individual scientists, training and education, funding, policies and procedures, tools, support systems and an ethical climate. Although these are presented as discrete items, they frequently overlap.„EMS administrators, managers and supervisors can influence each of the components in this framework.
For many years, EMS researchers were primarily physicians who developed study ideas and then requested participation by„EMS systems. However, more and more„EMS professionals are becoming researchers, with some of them pursuing advanced training through Master_s- and Doctorate-level education. It is advantageous for progressive„EMS systems to cultivate relationships with these traditional researchers. With the right relationship, these scientist will not only bring forth studies for implementation in a system, they can help with decisions about participating in other studies, and with evaluating the evidence behind proposed new interventions before they are implemented.
Of course, not all researchers will be formally trained research scientists. Within any EMS system, there are likely to be„EMS professionals with an interest in research. Administrators, managers and supervisors should foster those interests. These ˙interestedÓ„EMS providers can play an important role in implementing research studies, serving as study coordinators or liaisons with the primary investigators. They may also be an important source of study ideas, identifying important questions that need to be addressed through research.
One advantage of supporting emerging researchers within an EMS system is that it opens up an additional career track for„EMS professionals. While it is not yet commonplace, most„EMS systems could benefit from a ˙research officerÓ position (which is — or at least should be — different from a quality improvement or training officer). Such a position would provide a point person for a system_s research activities, as well as provide an additional mid-level leadership position that could be used to promote career development.
Training and Education
It_s unrealistic to expect every„EMS provider to be a trained scientist, just as it_s unrealistic to expect that of every physician, nurse, or engineer. For some studies, it may be possible to use only a small cadre of interested„EMS providers to collect data, but larger studies will require broader participation. Therefore, every„EMS provider should have at least a basic understanding of research principles. Administrators, managers and supervisors can ensure that all employees of an„EMS system receive adequate education about general research principles as a part of the ongoing continuing education program. It_s also important for system leaders to reinforce the importance of research and promote provider buy-in.
Some EMS professionals will want more than a general understanding of research, and„EMS systems should support the pursuit of more formal research education to the same extent as they support other interests. Sending a provider to a course to attain better research skills can be as valuable to an organization as, for example, sending the provider to an advanced extrication course or an ACLS instructor course.
It_s also important to educate the public about the„EMS system and its research activities. Some studies will require community consultation and public disclosure prior to implementation. The more the public knows about an„EMS system and the research it has done, the easier that process will be. This is win-win: educating the public about EMS research is an opportunity to promote the„EMS agency.Funding
Research costs money. When systems participate in small studies that require few resources, they often absorb any costs associated with those studies. It_s appropriate for systems to include some research infrastructure as part of their basic operating costs. As the size and number of studies grows, however, systems may have to explicitly fund those activities. For example, if a study requires 75 employees to participate in two hours of study-related training, those employees should be paid for that time — and study-related funds should cover those costs.
Larger studies are usually supported through grants or contracts, and it is appropriate for„EMS systems to be compensated for their efforts on those studies, just as the hospital laboratory or pharmacy expects to be paid for their study-related services. This may be in the form of a single lump-sum payment, or a small amount paid for each subject enrolled. Be reasonable. While actual costs should be compensated, research will not be a get-rich-quick panacea for any„EMS system.Policies & Procedures
Research is protocol driven, and strict adherence to the study protocol is of the utmost importance. That is one advantage that EMS systems have in doing research:„EMS systems and providers are well adapted to protocol driven activities. Still, it_s useful for progressive„EMS systems to consider and/or include research issues in their policies and procedures. When studies are taking place, complete research data should be as much a priority as complete medical and billing data. Also, enrolling subjects, collecting data, and completing data forms should be made a part of all job descriptions.Tools
EMS administrators, managers and supervisors need to ensure field personnel have the tools they need to successfully implement as study. ˙ToolsÓ can be many things, including such study-related supplies as necessary computers and communication equipment, record-keeping systems and data collection forms. The investigators will usually provide supplies, such as study medications or experimental devices. If supplies aren_t provided,„EMS systems should be reimbursed for their costs. Systems may need additional computer equipment and/or data storage media; whether those costs should be reimbursed by a single study or considered general infrastructure will depend on whether the equipment has a life beyond the single study.
Data collection tools deserve special mention. While study investigators will usually develop and provide data collection forms, it is incredibly useful for field personnel — the people who will be using the forms — to have a hand in their creation. This requires a pre-existing relationship with investigators, and that administrators, managers and supervisors allow work-time for interested providers to participate. Such relationships can ensure that data collection processes are realistic and streamlined; in research it is generally not a good idea to collect large amounts of data just because it is available, data collection should focus on the specific research question at hand.„Support Systems
One integral support system in„EMS is medical direction.„EMS systems that participate in research must have an involved, supportive medical director. The medical director must be involved in decisions about participating in studies, and should review and approve all study protocols. This may be a thorny process for systems that only occasionally participate in research; it will become more streamlined with experience.
Data systems are also important to research. Administrators, managers and supervisors should support use of a consistent, uniform data collection process that at a minimum includes the NHTSA-developed prehospital dataset and provides data to the National EMS Information System (NEMSIS). System leaders will also have to ensure they have HIPAA compliant data-sharing agreements with researchers and participating hospitals.
Research ethics are different from medical ethics.„EMS systems that participate in research must ensure their personnel are well informed about research ethics. Most academic institutions provide education about research ethics, and study investigators can make that training available as part of the research project. Such training is usually available in an online, self-study format. Administrators, managers and supervisors will have to provide staff with the time necessary to complete the training, and make sure the training is completed. Again, employees should be compensated for this time, and research funds should be available to cover those costs.
The full extent of ethical issues is beyond the scope of this article, but consent is a key component of ethical research. Consent for research is different from and more complicated than consent for medical care. One major difference is that there is no such thing as ˙implied consentÓ for research. When research involves subjects who can_t provide informed consent, a specific process — including community consultation and public disclosure — must be completed before the study begins. As discussed briefly in the ˙Training and EducationÓ section,„EMS administrators, managers and supervisors will need to participate in that process.
In summary, EMS administrators, managers and supervisors can influence the research enterprise of any„EMS system in a number of areas. Some costs are associated with supporting research, but most of these costs can be absorbed as general system infrastructure or reimbursed from individual study funding. Providing„EMS personnel with support — in terms of time and resources — is the main way to ensure a successful research environment.Lawrence Brown is the author of ˙An Introduction to EMS ResearchÓ and a member of the JEMS editorial board.„Bob Audet is with Nature Coast EMS in„Citrus County, Fla.