Sorting Out Our EMS Research Priorities

I’d like to pose a question to you. Perhaps this is one of those questions that I should be happy to be asking. The entire idea of me needing…or even wanting to ask this question bodes well for the future of EMS. So *deep breath* here it goes.

What are the most pressing questions that EMS researchers should attempt to answer?

The reason I’m asking this question today is because of a string of comments I’ve recently received regarding EMS research. As an example, Bil (yes, one L) recently left a great comment on my post about the face flick as an assessment tool. Bil has done some thinking about appropriate use of painful stimuli and shared an excerpt of his previous writings. Bil is obviously a thoughtful and well educated EMS provider.

But Bil also leads off his comment with a very common question. One that brought me to my question. Follow me on this. Bil writes, “I would be curious to know what data or research/evidence exists about a facial flick. I like the concept but I am sure there is a right and a wrong way to effect the corneal reflex.” And that got me thinking.

My first thought was, yes, perhaps we should investigate the most appropriate means to stimulate the corneal reflex and then educate our EMS providers to use this method exclusively. The truth is, like so many other things in prehospital care, I’ve adopted the face flick as an assessment tool because I’ve used it and I find it clinically useful. But I can find no evidence of its appropriateness or clinical relevance in any research anywhere.

Initially, this concerned me. Should I only share EMS tips and tricks that are firmly grounded in peer-reviewed literature? In an arena of medicine like EMS, would such a thing even be possible? If it was possible, would it be useful? (And wouldn’t my blog sound a lot like Rogue Medic if I did?)

Then I began considering all of the assessments, treatments, decisions and interventions that we could apply to Bil’s question. We make hundreds of clinically relevant decisions on just about every call we run. Remarkably few of those decisions are based on well documented scientific research. Some of our most elaborate, time consuming and presumably life saving interventions have not a single shred of scientific evidence to back up their usefulness. That isn’t justification for abandoning the scientific method. On the contrary, it’s a call to action. Well…it’s a call to right action.

Surely we can demand evidence based, peer-reviewed research to guide our most important clinical decisions without calling for formal research into every thing we do. As the EMS research movement gets stronger and louder, I’m concerned that, in the tidal-wave of enthusiasm, we’re going to loose sight of the really important questions that research could address.

There is no question that action is needed more than ever, but we in EMS know better than anyone that action isn’t necessarily right action. We can look very busy and still accomplish nothing for our patient. In the same regard, we could invest in a slew of EMS research and still come up with very little relevant data to guide our care. And that brings me back to my question.

What are the most pressing questions that EMS researchers should attempt to answer?

I’m not asking that as a hypothetical question. I’d really like to hear your answer. I have some specific ideas of my own, but I’d like to hear your answers first. Get your pointer away from that browser back button. Go down to the comments section and leave me a response. Let’s get this conversation started.

Comments

  1. Rates of 911 utilization in high-use (DM, CHF, COPD etc) demographics targeted with preventative visits by extended scope of practice practitioners.
    Pt satisfaction and outcomes at 1 month with diversion to urgent care, walk in clinic, specialty clinic (diabetes management, etc) or next day MD appointment, with specific checklist criteria for each.
    RCT on spinal immobilization: australasian practice of careful handling, c collar, and soft mattress, vs vacuum mattress, vs. scoop, vs backboard.
    RCT on prehospital use of nexus/canadian c-spine rules.
    Outcomes with targeted early sepsis intervention, possibly with point of care lactate testing. Not sure if that should be aggressive fluid admin, or abx too.
    Anyway, there’s a few to get started with. Our profession’s problem is that there’s so little body of prehospital research to begin with that many of our common treatments haven’t been researched at all, or haven’t been confirmed in our rather unique setting.

  2. Donna Wooten says:

    I need to know what the chemicals are so that I may not have them in my house. I have a son that has constantly threaten suicide and is researching this method. Please help!

  3. Micah Gray says:

    I second the need for more/better research on the effectiveness and benefits of spinal immobilization, versus the potential damage caused by it. I work in a city with extremely aggressive spinal immobilization protocols, and I’m feeling more and more that we may be doing more harm than good a large percentage of the time. A second issue I’m interested in seeing more research on is the necessity of code three response on most 911 calls, and the potential for reducing code three responses, and lowering associated risks. Thanks for the great question, Steve!

  4. Andy Biddle says:

    Great question Steve. I would love to see more research into fluid resus for hypovolemic shock, and what types if any are good for patients. Also to study what benefit if any are our drugs we give for cardiac arrest, looking specifically at survival to discharge. Though I think for me the biggest need might not be clinical, but to research the way we educate EMT’s and Paramedics and make us a true profession.

  5. Personally, I am most interested in research about the efficacy of different education methods … high fidelity patient simulation, online lectures, classroom lectures, case discussions, online simulation, etc.

  6. In the UK we have the Journal of Paramedic Practice, a peer reviewed, evidence based publication. I have seen articles looking a t most, if not all the above subjects. A start would be an international version of this. I believe JPP may have attempted this. I’m not sure if it still runs though.

    All the best,

    Tj

    @meditude

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