MAKING RESEARCH A PRIORITY
Jensen JL, Blanchard IE, Bigham BL, et al. The Canadian National EMS Research Agenda: Impact and feasibility of implementation of previously generated recommendations. CJEM. 2015;17(5):484–490.
Is research just an academic exercise? Does it really impact the care we provide in the field? Over the past decades our EMS culture has struggled to implement evidence-based practices. In general, we don’t seem to value research nor support the elements needed to conduct it.
Background: The authors of the Canadian EMS Research Agenda made several recommendations in 2013—the full list is available online at www.paramedicchiefs.ca/nra.
Methods: In this recent study, the primary authors of the Canadian agenda set out to analyze the feasibility and impact of the 2013 recommendations using an online survey to poll stakeholders. They used snowball sampling to expand the significance of the study.
Participants were invited via email to score the impact and anticipated ease of implementation of the 19 previously identified agenda items using a five-point Likert scale. This methodology allowed the authors to identify quick wins (i.e., easy implementation of high-impact strategy) in an effort to guide future strategic planning.
Results: Of the 131 invitees, 94 (71.8%) responded. The easiest recommendations to implement with the highest impact included: 1) Strengthening research partnerships between EMS academic centers, systems, regulators, educators and national associations; and 2) Strategically marketing the importance of EMS research to other agencies, health groups and the public.
The authors also identified dissemination of information and providing scholarships to support the EMS provider doing research as key elements.
Discussion: Why is this significant? In 2001, a National Highway Traffic Safety Administration-funded National EMS Research Agenda identified many similar recommendations, identifying a lack of well-trained researchers and lack of funding as significant barriers towards advancing our research goals. Although implementation of this agenda may be ongoing, no formal progress reports have been published and progress appears to be very slow.
The NHTSA agenda also identified secondary barriers, such as EMS provider lack of appreciation or understanding for evidence-based practices—the capturing and sharing standardized data to achieve higher standards of care.
Each of us on the street must learn to be more mindful of our data practice. We’re not just clicking boxes on a patient care report, we’re building the evidence needed to justify our existence. It’s unacceptable to have our databases filled with inaccurate data simply because we made inattentive errors. But beyond this documentation, it’s key that we review, research, collaborate and publish what we already know from the data we have.
The current National EMS Information Systems data set (www.nemsis.org) and EMS Compass performance measures initiative (www.emscompass.org) may help drive a change in our culture, but we also need to invest in a national infrastructure to overcome obstacles impeding research. Collaboration between expert researchers in educational venues and field providers can create fellowships and research positions, such as the one created by the National Registry of EMTs.
Research literacy must be incorporated into the classrooms of every EMS provider so that evidence-based decision-making is the norm. And of course, we need our leaders to help forge the relationships so that outcome data is captured and used in our systems to improve care.
Although it’s commendable that this Canadian study captured responses from over 100 EMS leaders (managers, physicians, educators and researchers), it only included five responses from EMS providers. As my mentor and Founding Director of the Prehospital Care Research Forum Baxter Larmon, MICP, PhD, likes to say: “EMS providers at all levels must take control of our future, proving with science that what we do makes a difference.”
Visit www.pcrfpodcast.org for audio commentary.
Snowball sampling: A non-probability method of recruiting more people to participate in a study by having current subjects recommend acquaintances.
What we already know: Progress implementing the NHTSA’sNational EMS Research Agenda is slow-going, with little progress made on removing barriers like a lack of well-trained researchers or funding.
What this study adds: As progress is made in Canada, it reminds us there are things every field provider can do to contribute to evidence-based studies that will lead to higher standards of care.