Administration and Leadership, Exclusives, Operations

The Priority and Future of Research in EMS

Allina Health EMS Researcher Lori Boland, MPH
At Allina Health EMS, a small research team works inside the St. Paul, Minnesota-based EMS agency, which has more than 600 care providers and serves more than 100 communities in the region. We sat down with Lori Boland, MPH, principal research scientist at Allina Health EMS, to discuss the importance of research in EMS.

Lori is a clinical epidemiologist who collaborates with emergency medicine physicians and prehospital clinicians in support of investigator-initiated research in the area of emergency services at Allina Health EMS. She earned her MPH in epidemiology with an emphasis in cardiovascular disease from the University of Minnesota. Her primary research interests include prehospital management of sudden cardiac arrest, mechanical compression, CPR quality and EMS provider well-being.

Q: Why is peer-reviewed and agency-led research important in the field of EMS?

A: Research is really the best way to build a solid body of evidence for any practice in medicine. It’s empirically based so that you’re not just guessing at what might work. You’re actually proving what does work or what doesn’t work, which is equally important. In conducting research at an EMS agency, we are doing applied setting research and contributing to the evidence-base about the practice of prehospital care.

Like every EMS agency, our patients are our number one priority. By doing research, we are informing how the actions we take can improve the care for our patients. The other thing I would say is that doing research is good for business. Research helps us focus on delivering high-quality care and informs decisions about how to optimize resources, either to achieve greater operational efficiency, enhance our provider environment or improve patient care. By doing studies, we can make these decisions based on empirical evidence not just anecdotal observations.

Q: How would you describe the EMS’s industry relationship with research and evidence-based practice?

A: I think there’s been tremendous growth in the field of EMS research. If you look at the practice of EMS, it’s evolving rapidly. Our medics are being asked to do things in the field that even 10 years ago would have been unheard of. So whether it’s because of advanced technologies or just a greater desire by the profession to do more for patients in the field, we are asking our clinicians to do a lot more. Alongside that, we need to study how well we are doing these things and whether these advances ultimately benefit our patients.

Another thing that has made a big difference is the transition to electronic patient care records. Only about 10 years ago, a lot of us were still using paper charts. But electronic records are a game changer in terms of our ability to assemble and analyze data and the potential for research.

Q: What are the current research priorities at Allina Health EMS?

A: We try to live by the mantra it’s only worth researching if it offers an opportunity to improve patient care or provider well-being. Some of our research and measurement activities have focused on bread-and-butter care like studying whether our STEMI patients are getting aspirin when they should be.

But we also try to focus on issues with contemporary relevance, for example, understanding the opioid epidemic and EMS’s role in access to opioids. A few years ago, we changed our pain management protocol change in an effort to be more judicious about how we’re distributing narcotics in the field. Then we did a before and after look at what happened after we changed the protocol. We found that we have been able to achieve a 46% reduction in the prehospital use of opioids across our system without much difference in patient-reported pain scores.

Another topic we focus on is sudden cardiac arrest because it’s one of the more time-sensitive conditions in which EMS has a large role to play in survival. Often research on this topic focuses on one care domain for example in-hospital care or prehospital care. But because we are a hospital-based EMS system, we have recently tried to take a more a systematic look and examine if Allina as a system is meeting as many of the recommended guidelines as we can. We are looking at dispatch data, data on first responders and whether they used AEDs or started compressions. We are looking at our role in training community members to respond appropriately as well as what happens in the hospital.

Q: Can you tell us about the evolution of Allina Health’s in-house research team and its current makeup?

A: Our team is essentially myself, as a senior research scientist and Jessica Jeruzal, our part-time research assistant, who is currently a graduate student at the University of Minnesota. We’re supported by our two medical directors, Charlie Lick, MD, and Andrew Stevens, MD, who serve more as research idea generators and consulting sounding boards. They’re often extremely critical at the very beginning of the research process and also at the end in terms of what we try to present or publish. They also play a key role in initiating and fostering external partnerships.

The focus on research at Allina Health EMS really started when I was working with the larger research team located in the corporate offices at Allina Health. The EMS leadership team was looking for support in publishing a paper about being the first ambulance service in the United States to put a LUCAS device on every truck. I helped them produce an implementation paper which became their first peer-reviewed publication and then over the years did a few more projects on prehospital sepsis and other topics.

Three years ago, I transitioned over to EMS and became a dedicated resource embedded with this team. One of the keys to having dedicated research staff had been the support of our leadership, our medical director and our chief, who wanted research to be integrated as a part of what we do at Allina Health EMS. I think the EMS community itself is pretty hungry for research and to innovate and explore new ideas, you have to have research and really study what works and what doesn’t.