ADVERTISEMENT
Areas for Research in EMS
This article is excerpted from Why Research Is Important in EMS.
If EMS is to continue its professional evolution and become a respected member of the healthcare community, it is critical that prehospital clinical decisions be made on the basis of good research.
Here are some key areas where research will be critical to the future delivery of prehospital clinical care:
Airway Management
The safety and efficacy of advanced airway management by EMS remains under question, while the administration of high-flow oxygen is becoming increasingly suspect for certain conditions. Additional research in the prehospital setting will be necessary to inform any changes to existing indications for these interventions.
Cardiac Arrest
In the context of out-of-hospital cardiac arrest, important EMS research questions abound. Recently the effectiveness of mechanical CPR devices has been the subject of much debate. Several research studies have found the devices improve end-organ perfusion and increase return of spontaneous circulation.1 Large clinical trials, however, have concluded the devices do not provide a benefit in terms of survival to discharge and neurologic outcome.2–4 Similarly, researchers are still searching for evidence of increased survival from the administration of cardiac medications during cardiac arrest.5,6 The same is true for the use of impedance threshold devices, though researchers have recently presented evidence that ITDs may improve survival to discharge if high-quality CPR is performed.7,8 More study will likely be required to confirm their findings.
TXA
Research in the prehospital setting is also needed to support the newest clinical interventions in EMS, such as the administration of tranexamic acid (TXA) to control major traumatic hemorrhage. While TXA has been demonstrated to improve survival in the military setting, the evidence for its use in civilian trauma is very limited.9 No published research has examined the use of TXA in a civilian EMS system.
References
1. Westfall M, et al. Mechanical versus manual chest compressions in out-of-hospital cardiac arrest: a meta-analysis. Crit Care Med, 2013, 41(7): 1,782–9.
2. Perkins GD, et al. Mechanical versus manual chest compression for out-of-hospital cardiac arrest (PARAMEDIC): a pragmatic, cluster randomised controlled trial. Lancet, 2015 Mar 14; 385(9,972): 947–55.
3. Wik L, et al. Manual vs. integrated automatic load-distributing band CPR with equal survival after out of hospital cardiac arrest. The randomized CIRC trial. Resuscitation, 2014; 85(6): 741–8.
4. Rubertsson S, et al. Mechanical chest compressions and simultaneous defibrillation vs conventional cardiopulmonary resuscitation in out-of-hospital cardiac arrest: The LINC randomized trial. JAMA, 2014; 311(1): 53–61.
5. Lin S, et al. Adrenaline for out-of-hospital cardiac arrest resuscitation: A systematic review and meta-analysis of randomized controlled trials. Resuscitation, 2014; 85(6): 732–40.
6. Neumar RW, et al. Part 8: Adult advanced cardiovascular life support: 2010 American Heart Association guidelines for cardiopulmonary resuscitation and emergency cardiovascular care. Circulation, 2010; 122(18 suppl 3): S729–S767.
7. Aufderheide TP. A trial of an impedance threshold device in out-of-hospital cardiac arrest. New Eng J Med, 2011; 365(9): 798–806.
8. Yannopoulos D, et al. The effect of CPR quality: A potential confounder of CPR clinical trials. Abstract presented at AHA Resuscitation Science Symposium. Resuscitation, 2014; 130(s2): A9.
9. Cole E, et al. Tranexamic acid use in severely injured civilian patients and the effects on outcomes: a prospective cohort study. Ann Surg, 2015 Feb; 261(2): 390–4.
Mario J. Weber, JD, MPA, NRP, is a paramedic and field training officer at the Alexandria (VA) Fire Department, where he focuses on quality management, advanced training and evidence-based protocol development. He also reviews quality assurance cases and advises on the ALS training program for the Montgomery County (MD) Fire and Rescue Service. Reach him at mario.weber@m10.solutions.
Michael Gerber, MPH, NRP, is an instructor, author and consultant in Washington, DC. He is also a paramedic with the Bethesda-Chevy Chase Rescue Squad and previously worked as an EMS supervisor for the Alexandria (VA) Fire Department. Gerber has experience as an EMS educator and quality management coordinator and has presented original research at state and national EMS conferences. Reach him at mgerber@redflashgroup.com.
