RESEARCH

National EMS Research Agenda

A national investment of time and effort in EMS research is necessary to overcome obstacles that currently prevent EMS from gathering the essential evidence of its positive effect on patient care and patient outcomes. Collecting and analyzing this evidence is the key to improving the overall health of the community in a competitive and cost-conscious health care market. Most importantly, research is essential to ensure that the best possible patient care is provided in the prehospital setting. EMS professionals deserve the benefit of research to assist them in providing the best possible care in the challenging circumstances they encounter.

The National EMS Research Agenda is a joint project of NHTSA and the Maternal and Child Health Bureau (MCHB) of the Health Resources Services Administration (HRSA). It describes the history and current status of EMS research. Impediments to the growth of scientific investigation in the field are identified; and strategies are suggested for improving the quality and quantity of EMS research with the goal of providing a scientific foundation upon which to base current and future prehospital care. Its companion document, the National EMS Research Strategic Plan, takes a broad look at the research needs within EMS, and establishes a plan for investigating those items, with priority items identified by a consensus process by a multidisciplinary group of EMS experts. The third phase of the EMS Research Project is to address EMS research ethics, including the consent process for research in emergency situations.

The National EMS Research Agenda was developed in parallel with the CDC’s Acute Injury Care Research Agenda: Guiding Research for the Future. In addition, our Federal partners at the Agency for Healthcare Research and Quality (AHRQ) have just approved small-conference funding to combine with our project funding to support an EMS Research Ethics Conference. The purpose of the conference is to serve as the impetus for development of a guidance document to address issues of both consent and ethical conduct for EMS research. Dates and other details for the conference are currently under discussion. For more information on the National EMS Research Agenda, the National EMS Research Strategic Plan, or the upcoming EMS Research Ethics Conference contact Susan McHenry.

THE EMS SYSTEM

Technology and EMS Project

Technology is producing more gadgets and making more information available every day. But how can you make sure that technology will provide useful information? And most important, how can you tell if new technology makes a difference? Many new technologies have great potential for their application to emergency medicine and the improvement of emergency care. But there is no coordinated method for determining the clinical utility or the effectiveness of new technologies before they are deployed in EMS – at least not today.

Consumers of EMS technology could benefit from a guide designed to assist in the evaluation of new technology. This guide could help the consumer to ask informed questions when considering new technologies. The National Association of EMS Physicians, funded by the Intelligent Transportation System’s Public Safety Program, and through a multi-disciplinary Technical Consultation Committee (TCC), has developed an “EMS Technology Assessment Template” (EMSTAT) which can be used by EMS technology developers, manufactures, and consumers in the evaluation of new technology. The EMSTAT may also help guide manufacturers and EMS technology consumers when considering the development of trials to evaluate the performance of new technology.

The EMS Technology Assessment Template is designed to evaluate information technology and EMS devices that provide raw data about patients, evaluation-oriented clinical patient information, or decision support tools. The template may also be used by local consumers (e.g., EMS medical directors or administrators) to determine assessment criteria for other types of EMS equipment and treatments.
During a summer meeting, the multidisciplinary Technical Consultation Committee finalized the latest version of EMSTAT, and discussed strategies and options for its use on an ongoing basis. If you would like more information on EMSTAT or the Technology and EMS project, contact Laurie Flaherty.

Field Triage of Trauma Patients

EMS providers are well aware of the importance of field triage of trauma patients. Field triage is the process by which prehospital EMS providers determine which trauma patients are the most seriously injured. This process determines the order, speed, and destination of transport. Triage decisions can impact whether trauma patients live or die. Their accuracy is essential for the effective use of limited medical resources. “Under triaging” of patients may cause preventable death and disability. “Over triage” of patients will tax increasingly challenged EMS and hospital resources.

The American College of Surgeons Committee on Trauma’s (ACS/COT) Resources for Optimal Care of the Injured Patient: 1999 Field Triage Decision Scheme serves as the basis for many State and local trauma triage protocols. Updating these national field criteria will ensure that the most current and the best available information will be used to make field triage decisions.

For example, for victims of car crashes, it may be important to incorporate information from new technologies such as advanced automatic crash notification (AACN). Many factors with direct influence on the severity of injury, such as airbag deployment and other AACN data could be incorporated into these nationally promulgated field triage criteria.

A multidisciplinary panel of national experts representing EMS, emergency medicine, trauma surgery, and public health was selected by CDC’s Division of Injury Response and NHTSA’s Office of EMS to take on the task of revising, publishing, and disseminating model national trauma field triage criteria.

As a foundation for its work, the panel used the Field Triage Decision Scheme published in the ACS/COT’s Resources for Optimal Care of the Injured Patient: 1999. Experts met three times between March 2005 and April 2006 to revise this document. The meetings were facilitated by Dr. Jerry Jurkovich, vice chairman of ACS/COT.

Based on the best available scientific evidence combined, when necessary, with expert opinion, new criteria agreed upon by the expert panel will be included in the upcoming revision of the ACS/COT’s Resources for Optimal Care of the Injured Patient. This project is funded by CDC’s Division of Injury Response, HRSA’s Emergency Medical Services for Children program, and the Office of Emergency Medical Services at the National Highway Traffic Safety Administration.

The national trauma field triage criteria are primarily intended for the prehospital EMS provider and, through a comprehensive implementation strategy, could be incorporated into other documents, textbooks, and publications. Implementation of these guidelines will help assure prehospital EMS providers appropriately recognize, treat, and transport injured patients, including those from highway crashes, to the most appropriately equipped and staffed medical facilities. For more information on the Field Triage Project, contact Drew Dawson.