Paramedic-led research

[sir.shocksalot]

I wanted to gather some people's thoughts and just start a discussion regarding Paramedic-led research. By this I mean peer-reviewed research/journal articles that were entirely written and conducted by Paramedics.

Does anyone currently participate or have begun conducting studies relating to prehospital care? I have seen only a handful (if that) of journal articles that were authored by paramedics, and I think most of them had several physician authors as well.

What do you think are the barriers to conducting research at the paramedic level? Do you think there is a place in the medical community for paramedic-led studies? What sort of studies would you like to see done?

My opinion is that the barriers to research are largely educational with a dash of cultural barriers. I personally have no idea where to get started to conduct a large study like ones I have read in peer-reviewed journals. I also have no idea how to get a hold of the large swaths of data that would be required for a simple retrospective study. And lastly, I lack the statistical chops to meat through such data and arrive at any sort of conclusion.

I think the cultural barriers would mostly be encountered when attempting to conduct a prospective study, a lot of my coworkers would probably remark "why do you want to do that?" or "what's the point?" or "isn't that a doctor's job?". I also would probably have a hard time finding enough people to help me out to preform a study.

The two studies that I think are most vital to furthering EMS currently is studies concerning education length/depth/breadth and patient outcomes and another study regarding skill degradation and the number of paramedics per capita in a community.

 

[JakeEMTP]

Your poll does not adequately represent the barriers for EMS and research. It appears to be more ego based then that of reality.

In almost every article that discusses the barriers in EMS research these five factors are mentioned.

Inadequate funding

Lack of integrated information systems that provide for meaningful linkage with patient out-comes

Very small number of academic research institutions with long-term commitments to EMS systems research

Overly restrictive informed consent interpretations

Lack of education and appreciation by EMS personnel regarding the importance of EMS research.

To get pulbished the process can be complex and lengthy depending on the journal. Of course just about anyone can write some opinionated article for JEMS reviewing someone else's work.

Professional journals catering to the research world will want proper manuscripting, licensing and consent forms if trialing new meds or equipment which in that can be very detailed and will require a physician and the article must be able to pass a very critical peer review process. It is rare a journal will take first time publishers without someone who already has published in the mix as first author status.

Very, very few Paramedics will have an introductory course in statistics and even fewer will have any course on EBM and research reading. Taking a course in grant writing should also be covered. Some journals may look at the education level fo the lead researcher and want at least a Masters degree. Those granting the funding may also look at the education level and physician participation may be a big factor.

The professional insurance for liability during any research study may have to fall on the physician. Gaining access to protected data may have to fall with the physician. Conducting research concerning the education levels of other employees may have to fall to the physician, HR and the unions since employees also have privacy rights.

The turnover in an EMS agency and the length of time it takes to plan, fund, initiate, gather the data and publish may also need to be looked at. Those who initiate a study may more on during the time it takes to perform the research. Usually companies will retain the rights to that study and if no one else wants to continue it due to lack of interest, the study is shelved or scrapped.

Also, since EMS has not reached the levels of higher education like other professions to where educators have a requirement to publish, there is no motivation nor mentoring. In other countries where the education of the Paramedic is a minimum of a Bachelors degree and then a Masters for advanced, research will be included. This can be the turning point for sparking an interest in research with experience in the process by the time you enter the field for a career.

 

[sir.shocksalot]

Your poll does not adequately represent the barriers for EMS and research. It appears to be more ego based then that of reality.

I'm not sure what you mean by ego based, my knowledge of research is almost non-existant and this thread is largely to expand that knowledge and seek other peoples opinions. In all honesty the poll was just a way to see the gist of what people think without them necessarily having to post a reply.

Also, since EMS has not reached the levels of higher education like other professions to where educators have a requirement to publish, there is no motivation nor mentoring. In other countries where the education of the Paramedic is a minimum of a Bachelors degree and then a Masters for advanced, research will be included. This can be the turning point for sparking an interest in research with experience in the process by the time you enter the field for a career.

I can't agree more. Almost every research article I have read that has had paramedics as some of the authors have come from Australia or the UK, and both countries have paramedics with graduate level education. I also hadn't considered the lack of university programs for paramedics and how that would affect the number of studies being done. On the flip side NAEMT is the closest equivalent that paramedics have to a professional (I use that term very loosely) association, could NAEMT start funding and assisting in studies? (this is purely hypothetical, NAEMT is largely worthless and would never do such a thing, this is just a thought exercise).

It sounds like you have quite a lot of knowledge regarding studies and research. Have you participated in research in a different field?

 

[JakeEMTP]

I'm not sure what you mean by ego based, my knowledge of research is almost non-existant and this thread is largely to expand that knowledge and seek other peoples opinions. In all honesty the poll was just a way to see the gist of what people think without them necessarily having to post a reply.

Your poll mostly has all or none selections.

Research is a team effort and should be done in collaboration with others and not attempt to exclude those who can write the protocols or can be liasons for obtaining information.

If you look at journals like Rusucitation, BMJ Emergency Medicine, Canadian Journals of EM, Scandinavian Journals and Prehospital Journal of medicine, you will see thousands of articles about prehospital studies. But, there is a difference in the other countries to the extent EMS has been taken at a professional level career with minimal degrees required rather than an add on or votech cert requiring a few hundred hours of training. The European countries are also leaders in much of the medical equipment the US uses so the US as a whole watches their research. You can also use the ambulance designs which are now entering the US as an example for that.

The NAEMT should promote research but in no way be responsible for funding it.

 

[EpiEMS]

Of course paramedics and EMTs should be conducting our own research. The problem is, there aren't enough masters and doctorate level educated practitioners, not to mention a dearth of bachelors trained folks who can do the grunt number crunching.

It really is criminal that there aren't EMS professional/researcher programs.

Caveat: I'd love to do an MHA or MPH into a PhD in epidemiology so I could do EMS and trauma-related research.

 

[Veneficus]

I voted they should be leading research.

However, I agree at the present time, there are many barriers that have to be overcome.

The very worst thing that could happen is it could wind up like nursing research.

 

[EpiEMS]

The very worst thing that could happen is it could wind up like nursing research.

It's a valid concern, but since EMS is based on a medical model, wouldn't it be less likely?

 

[Veneficus]

It's a valid concern, but since EMS is based on a medical model, wouldn't it be less likely?

Probably not.

Most nursing research seeks to validate current practices or desired practices.

The very worst nursing study I saw was one done to show patients prefer nurses to wear a color other than white to identify themselves.

The methods and conclusions were highly biased and I took the time to look it over for a friend of mine who is a nurse in order to suggest how to improve the model.

What the author basically proved was patients like to identify which healthcare providers are which. (which has already been established)

However, the questionaire used negatively implicated nurses in white, which would likely cause people not to choose it.

Nursing studies are like studies coming out of China, there may be a few good ones that get over looked, but most are so bad that none of them get serious consideration.

 

[JakeEMTP]

Of course paramedics and EMTs should be conducting our own research. The problem is, there aren't enough masters and doctorate level educated practitioners, not to mention a dearth of bachelors trained folks who can do the grunt number crunching.

Who is going to write your protocols and carry the professional liability issues and credibility when it comes to consent and responsibiity for oversight?

There is nothing wrong with having physician involvement.

It really is criminal that there aren't EMS professional/researcher programs.

There are programs even in the US for research projects. Seattle's Medic One has a foundation but is also affiliated with a university and teaching hospital. Their Paramedic program is supposed to be one of the best but it is not an Associates degree.

Southern California has had many research projects.

UCSD has an EMS fellowship for physicians who are wanting to be involved in research and other aspects of EMS.

Pennsylvania has a couple of noteworthy research centers for EMS and so does Florida but again you can not forget the physician. Just about every state has research ongoing for EMS. The AHA also sponsors many studies throughout the country for EMS agencies to participate in if you want to be part of something. So do some equipment companies. Your agency and medical director just has to express an interest. Some agencies just don't have the interest for a variety of reasons and alot of it comes back to the culture of EMS. The "what's in it for me" instant gratification usually supercedes any potential long term benefits. Even Medic One has seen that now as they have expanded their area served by different FDs.


If some in EMS are going to wait until the US raises its education standards before more get involved in research because they don't want physician involved, some might be waiting a long time and will just continue to use this as an excuse to not see feasible opportunities for research that exist now.

 

[Sandog]

Research requires a very precise methodology with a good understanding of the scientific process. I am afraid most EMS personnel are lacking the training required to undertake such a task.

Assist in research yes, conduct, no.

 

[EpiEMS]

Probably not.

Most nursing research seeks to validate current practices or desired practices.

Sounds like bad research, to me. How in the heck does it get published, then? Just nursing journals? I've not seen a nursing study published in NEJM or, say, Science (or Nature) recently.

Who is going to write your protocols and carry the professional liability issues and credibility when it comes to consent and responsibiity for oversight?

Your peers provide oversight. Say, the "American College of Prehospital Emergency Medicine"? You'd be an independently licensed practitioner, just like prehospital providers in Australia and the UK. You carry your own insurance. Of course, this is all predicated on EMS being better educated (mandatory college education, perhaps).

There is nothing wrong with having physician involvement.

Yes, I agree that physicians are arguably the "gold standard" of medical providers, but that doesn't preclude the existence of educated, licensed, and most importantly, self-regulating prehospital providers.

Just about every state has research ongoing for EMS...Some agencies just don't have the interest for a variety of reasons and alot of it comes back to the culture of EMS. The "what's in it for me" instant gratification usually supercedes any potential long term benefits. Even Medic One has seen that now as they have expanded their area served by different FDs.

Agreed, it seems like a cultural problem. We can fix it, by, as you say, raising education standards. I'd love to see more studies with authors like John Smith, NREMT-P, PhD or Jane Doe, NREMT, MPH.

 

[Veneficus]

Sounds like bad research, to me. How in the heck does it get published, then? Just nursing journals? I've not seen a nursing study published in NEJM or, say, Science (or Nature) recently

Mostly nursing journals, I doubt you will ever see a nursing study in the NEJM.

As it is a journal of medicine, not a journal of healthcare or nursing.

 

[JPINFV]

Research requires a very precise methodology with a good understanding of the scientific process. I am afraid most EMS personnel are lacking the training required to undertake such a task.

Assist in research yes, conduct, no.

I think this is one of those things where the issue is, "Where would I like to see EMS" vs "What is practical given the current situation."

 

[JakeEMTP]

Mostly nursing journals, I doubt you will ever see a nursing study in the NEJM.

As it is a journal of medicine, not a journal of healthcare or nursing.

Incorrect.

It doesn't even take much effort to see there are numberous articles in the NEJM by nurses and all nurses as the authors.

http://www.nejm.org/doi/full/10.1056/NEJMsa1001025

Many of the physican researchers list mostly RNs in the author title.

http://www.nejm.org/doi/full/10.1056/NEJMoa1114540

 

[EpiEMS]

Mostly nursing journals, I doubt you will ever see a nursing study in the NEJM.

As it is a journal of medicine, not a journal of healthcare or nursing.

There is lots of health policy and health services research in there, though.

I'd like to see EMS provider published research more often than there currently is.

 

[JakeEMTP]

I'd like to see EMS provider published research more often than there currently is.

Do you read Prehospital Emergency Care?

http://www.sciencedirect.com/science/journal/10903127

Or Resuscitation?

http://www.journals.elsevier.com/resuscitation/

Or Journal of Emergency Medicine?

http://www.jem-journal.com/

Several Paramedics have joined with physicians and nurses to do research and get it published.

 

[Veneficus]

Incorrect.

It doesn't even take much effort to see there are numberous articles in the NEJM by nurses and all nurses as the authors.

http://www.nejm.org/doi/full/10.1056/NEJMsa1001025

I am very surprised to see this considering the requirements for publication they put forth.

But it is not exactly of practice changing importance factor

I would also point out, that the lead author is not listed as a nurse.

http://healthpolicy.ucla.edu/Bio.aspx?staffID=130

Many of the physican researchers list mostly RNs in the author title.

http://www.nejm.org/doi/full/10.1056/NEJMoa1114540

Probably because the nurses took part in some aspect of the research?

It only seems fair.

 

[EpiEMS]

Several Paramedics have joined with physicians and nurses to do research and get it published.

I'm well aware of that, I just don't think it necessarily needs to be a requirement to have an RN or MD on a study -- you should be able to have your P-card and a PhD and publish as first author.

 

[JakeEMTP]

I'm well aware of that, I just don't think it necessarily needs to be a requirement to have an RN or MD on a study -- you should be able to have your P-card and a PhD and publish as first author.

If you look at the references I have provided you will see the Paramedic with MPH, Ph.D, MBA etc behind their name.

No one is saying a Paramedic can not do research or publish. But, in reality they will need the blessing of a medical director if it involves medication or equipment.

 

[JakeEMTP]

I am very surprised to see this considering the requirements for publication they put forth.

But it is not exactly of practice changing importance factor

I would also point out, that the lead author is not listed as a nurse.

http://healthpolicy.ucla.edu/Bio.aspx?staffID=130



Probably because the nurses took part in some aspect of the research?

It only seems fair.

Obviously you don't read the journals very often or bother to see who the authors are. Maybe if you did you would not have to backpeddle so much.