Emergency Medical Services Research Research Articles

Determining Potentially Avoidable Emergency Medical Services (EMS) Transports: A Population Level Study Using Linked Administrative Data in Alberta Health Services (AHS)

IntroductionTraditionally Emergency Medical Services (EMS) transports patients to Emergency Departments (EDs). However, some patients might be appropriately managed in alternative settings outside the ED. A number of non-traditional EMS programs have evolved in Alberta, in an attempt to provide quality care through a community-based care model.
 Objectives and ApproachThe project aimed to identify and quantify potentially avoidable EMS transports to EDs in Alberta.
 We identified 911 responses by ground ambulance in Alberta between September 1, 2017 and December 31, 2017. Patients 18 years and over transported to EDs were linked to Alberta Provincial Registry for more accurate demographic Information, and linked to Long Term Care (LTC) and ED data to capture patient characteristics and frequency of potentially avoidable EMS transports to EDs, defined as the Canadian Triage and Acuity Scale (CTAS) Level IV and Level V in EDs not requiring inpatient admission.
 ResultsWe identified 72,182 transports to EDs, of which 1 in 4 patients were rural residents. After excluding individuals<18 years and non-Alberta residents, we were able to match 58,137 of the 60,020 EMS transports to EDs (96.8%). Overall, 7,697 (13%) were triaged as less urgent with no hospital admission. Patients 65 years and over accounted for almost half (49%) of the transports in this cohort, 6% of which were for LTC clients. Percentage of potentially avoidable transports in LTC clients were similar to seniors living in the community (12%). Geographic visualization at the provincial level indicated variation across the province. In general, rural residents were more likely than urban residents to be transported to EDs with less urgent conditions (18% vs 12%).
 Conclusion/ImplicationsThis is the first analysis exploring potentially avoidable EMS transports to EDs in Alberta, Canada, where a comprehensive, single source of EMS system data is currently available. The project suggests opportunities for future EMS research and policies focusing on enhancing community–based care.

Promoting Continuing Professional Education and Research in Emergency Medical Services (EMS)

Promoting Continuing Professional Education and Research in Emergency Medical Services (EMS)

Evolution of emergency medical services in Saudi Arabia

Aim: The purpose of this study was to provide an overview of the evolution of emergency medical services (EMS) in Saudi Arabia to describe its history, organisational service providers, governance, EMS statistics and the educational development of the field with the disparity of educational approaches. Background: The EMS is an important part of the healthcare system as it is often the first point of contact for medical emergencies. The EMS in Saudi Arabia has seen a number of positive changes over the past decade, some of which include the development of several university and college programs dedicated to teaching EMS, the evaluation of the profession from a post-employment first aid model into a pre-employment bachelor's degree model, the generous governmental scholarship grants overseas and the official accreditation of EMS as a profession. It has been approximately nine years since the first EMS bachelor's degree programs were developed in Saudi Arabia, some of which were directly adopted from universities in developed countries such as Australia. Despite these positive changes, the current EMS system in Saudi is faced with many challenges, both organisational and educational, including the lack of research, community involvement, the educational status of practitioners and the inconsistencies of statistics relating to response time and rate of transfer. This paper describes the history of EMS in Saudi Arabia with a specific focus on identifying the disparity in the educational outcomes and approaches adopted by colleges and universities in the Kingdom. Methods: The data utilised for the research of the EMS profession in Saudi Arabia were obtained from the literature using search tools such as MEDLINE, Google Scholar, Saudi health journals, Saudi university websites, government reports and statistics. Conclusion: The EMS profession in Saudi Arabia has advanced greatly in the past 12 years. Yet there is still scope for considerable improvement, especially with regards to developing empirically identified core competencies for EMS bachelor's degree graduates. There is also the need for providing more outreach to the public to improve awareness of current services and available training, building more collaboration between the industry employers and academic institutions and investing further in EMS research through the development of Saudi-based postgraduate master's and PhD EMS degrees. This paper is the first to provide an overview of the EMS service in Saudi Arabia, for institutions and researchers to gain a better understanding of the history and current standing of the service from an educational and operational perspective.

Public Perception of Emergency Medical Services in the United States.

The objective of this study was to assess the public's experience, expectations, and perceptions related to Emergency Medical Services (EMS). A population-based telephone interview of adults in the United States was conducted. The survey instrument consisted of 112 items. Demographic variables including age, race, political beliefs, and household income were collected. Data collection was performed by trained interviewers from Kent State University's (Kent, Ohio USA)Social Research Laboratory. Descriptive statistics were calculated. Comparative analyses were conducted between those who used EMS at least once in the past five years and those who did not use EMS using χ2 and t tests. A total of 2,443 phone calls were made and 1,348 individuals agreed to complete the survey (55.2%). There were 297 individuals who requested to drop out of the survey during the phone interview, leaving a total of 1,051 (43.0%) full responses. Participants ranged in age from 18 to 94 years with an average age of 57.5 years. Most were Caucasian or white (83.0%), married (62.8%), and held conservative political beliefs (54.8%). Three-fourths of all respondents believed that at least 40% of patients survive cardiac arrest when EMS services are received. Over half (56.7%) believed that Emergency Medical Technician (EMT)-Basics and EMT-Paramedics provide the same level of care. The estimated median hours of training required for EMT-Basics was 100 hours (IQR: 40-200 hours), while the vast majority of respondents estimated that EMT-Paramedics are required to take fewer than 1,000 clock hours of training (99.3%). The majority believed EMS professionals should be screened for illegal drug use (97.0%), criminal background (95.9%), mental health (95.2%), and physical fitness (91.3%). Over one-third (37.6%) had used EMS within the past five years. Of these individuals, over two-thirds (69.6%) rated their most recent experience as "excellent." More of those who used EMS at least once in the past five years reported a willingness to consent to participate in EMS research compared with those who had not used EMS (69.9% vs. 61.4%, P=.005). Most respondents who had used EMS services rated their experience as excellent. Nevertheless, expectations related to survival after cardiac arrest in the out-of-hospital setting were not realistic. Furthermore, much of the public was unaware of the differences in training hour requirements and level of care provided by EMT-Basics and EMT-Paramedics. Crowe RP , Levine R , Rodriguez S , Larrimore AD , Pirrallo RG . Public perception of Emergency Medical Services in the United States. Prehosp Disaster Med. 2016;31(Suppl. 1):s112-s117.

P055: State of the evidence for emergency medical services (EMS) provision of palliative care: an analysis of appraised research from the Canadian Prehospital Evidence-based Practice (PEP) Project

Introduction: Patients who require end of life (EoL)/palliative care occasionally need assistance from paramedics. This review evaluated the evidence for paramedic-delivered EoL/palliative care interventions. Methods: The Canadian Prehospital Evidence-based Practice (PEP) Project methodology was used. A PubMed search was conducted, using Medical Subject headings and title/abstract key words. Titles and abstracts were reviewed for relevance. Studies were not required to be EMS based but must have focused on interventions available to EMS personnel. Included full text studies were scored by trained primary appraisers on a three-point Level of Evidence (LOE) scale (high = 1, moderate = 2 and low = 3) and three-point Direction of Evidence (DOE) scale (supportive, neutral, or opposing). Studies were categorized by clinical condition (n=5) and by intervention (n=25), and plotted on 3×3 (DOE × LOE) tables. The study primary outcome and setting were determined. Results: The search returned 3255 articles; 86 were selected for abstract review; with 30 full text articles ultimately included. Intervention recommendations were: LOE 1-supportive (n=3, 12%), 2-supportive (n=2, 8%), 3-supportive (n=2, 8%), 1-neutral (n=2, 8%), 2-neutral (n=2, 8%), 3-neutral (n=4, 16%). No primary studies were identified for 10 (40%) interventions. Conditions with 1-supportive studies were: ‘breathlessness’ and ‘analgesia’. ‘Secretions’ condition had no relevant evidence. Interventions with 1-supportive evidence were: Haldol for agitation (n=1), fentanyl and morphine for analgesia (n=3 and n=1), narcotics for breathlessness (n=1). No intervention had opposing evidence. Primary outcomes were more commonly related to symptom relief (n=26, 87%), safety (n=3, 10%), or tolerability (n=1, 3%). Only one included study was conducted in the EMS setting. Conclusion: Evidence for interventions used by paramedics in the treatment of patients requiring EoL/palliative care was identified, as were evidence gaps. Little research was conducted in the EMS setting, and most interventions had few studies. These PEP findings highlight topics requiring high quality EMS research specific to EoL/palliative care to inform this growing aspect of paramedic practice.

2015 Pediatric Research Priorities in Prehospital Care

Background: Pediatric prehospital research has been limited, but work in this area is starting to increase particularly with the growth of pediatric-specific research endeavors. Given the increased interest in pediatric prehospital research, there is a need to identify specific research priorities that incorporate the perspective of prehospital providers and other emergency medical services (EMS) stakeholders. Objectives: To develop a list of specific research priorities that is relevant, specific, and important to the practice of pediatric prehospital care. Methods: Three independent committees of EMS providers and researchers were recruited. Each committee developed a list of research topics. These topics were collated and used to initiate a modified Delphi process for developing consensus on a list of research priorities. Participants were the committee members. Topics approved by 80% were retained as research priorities. Topics that were rejected by more than 50% were eliminated. The remaining topics were modified and included on subsequent surveys. Each survey allowed respondents to add additional topics. The surveys were continued until all topics were either successfully retained or rejected and no new topics were suggested. Results: Fifty topics were identified by the three independent committees. These topics were included on the initial electronic survey. There were 5 subsequent surveys. At the completion of the final survey a total of 29 research priorities were identified. These research priorities covered the following study areas: airway management, asthma, cardiac arrest, pain, patient-family interaction, resource utilization, seizure, sepsis, spinal immobilization, toxicology, trauma, training and competency, and vascular access. The research priorities were very specific. For example, under airway the priorities were: “identify the optimal device for effectively managing the airway in the prehospital setting” and “identify the optimal airway management device for specific disease processes.” Conclusion: This project developed a list of relevant, specific, and important research priorities for pediatric prehospital care. Some similarities exist between this project and prior research agendas but this list represents a current, more specific research agenda and reflects the opinions of working EMS providers, researchers, and leaders. Key words: emergency medical technician; research; emergency medical services; priorities

A national research agenda for pre-hospital emergency medical services in the Netherlands: a Delphi-study.

BackgroundIn pre-hospital Emergency Medical Services (EMS) more research is needed to direct and underpin care delivery and inform policy. To target future research efforts, this study aimed to determine future research priorities with representatives of the EMS field.MethodsA four-round online Delphi survey was used to discuss different viewpoints and reach consensus on research priorities. A multidisciplinary panel of experts was recruited in the field of pre-hospital EMS and adjoining (scientific) professional organisations (n = 62). 48 research topics were presented in Delphi I, and the panel was asked to rate their importance on a 5-point scale. In Delphi II and III the panel selected their priority research topics, and arguments why and suggestions for research questions were collected and reported back. In Delphi IV appropriateness of the remaining topics and agreement within the expert panel was taken into account to make up the final list of research priorities.ResultsThe response on the Delphi-survey was high: 95 % (n = 59; Delphi I); 97 % (n = 60, Delphi II); 94 % (n = 58, Delphi III); 97 % (n = 60, Delphi IV). The panel reduced the number of research topics from 48 topics in Delphi I to 12 topics in Delphi III. A variety of arguments and suggestions for research questions were collected, giving insight in reasons why research on these topics in the near future is needed.Delphi IV showed an adequate level of agreement with respect to the 12 presented research topics. The following 9 topics were rated as appropriate for the national pre-hospital EMS research agenda: Non-conveyance to the hospital (ranked highest); Performance measures for quality of care; Hand over/registration/exchange of patient data; Care and task substitution; Triage; Assessment of acute neurologic signs & symptoms; Protocols and protocol adherence; Immobilisation; and Open/secure airway.DiscussionsThe research priorities identified in our study resemble those in other studies. However, the topic 'non-conveyance to the hospital' was determined as a priority in this study but not in other studies.ConclusionsThe national pre-hospital EMS research agenda can focus future research efforts to improve the evidence base and clinical practice of pre-hospital emergency medical services. Dissemination and implementation of the research agenda deserves careful attention.

The Canadian National EMS Research Agenda: Impact and Feasibility of Implementation of Previously Generated Recommendations.

A recent mixed-methods study on the state of emergency medical services (EMS) research in Canada led to the generation of nineteen actionable recommendations. As part of the dissemination plan, a survey was distributed to EMS stakeholders to determine the anticipated impact and feasibility of implementing these recommendations in Canadian systems. An online survey explored both the implementation impact and feasibility for each recommendation using a five-point scale. The sample consisted of participants from the Canadian National EMS Research Agenda study (published in 2013) and additional EMS research stakeholders identified through snowball sampling. Responses were analysed descriptively using median and plotted on a matrix. Participants reported any planned or ongoing initiatives related to the recommendations, and required or anticipated resources. Free text responses were analysed with simple content analysis, collated by recommendation. The survey was sent to 131 people, 94 (71.8%) of whom responded: 30 EMS managers/regulators (31.9%), 22 researchers (23.4%), 15 physicians (16.0%), 13 educators (13.8%), and 5 EMS providers (5.3%). Two recommendations (11%) had a median impact score of 4 (of 5) and feasibility score of 4 (of 5). Eight recommendations (42%) had an impact score of 5, with a feasibility score of 3. Nine recommendations (47%) had an impact score of 4 and a feasibility score of 3. For most recommendations, participants scored the anticipated impact higher than the feasibility to implement. Ongoing or planned initiatives exist pertaining to all recommendations except one. All of the recommendations will require additional resources to implement.

Research in Prehospital Care: Overcoming the Barriers to Success

Objective. The objective of this project was to determine how investigators conduct clinical trials in the prehospital setting and to suggest how emergency medical services (EMS) systems can develop the capacity to conduct prehospital clinical research. Methods. A representative sample of U.S.-based study sites was selected from all studies registered on clinicaltrials.gov since the year 2000, where prehospital care providers conducted study-related activities in the prehospital setting. The site principal investigator and the research coordinator or EMS liaison were invited to participate in a structured discussion. A single interviewer conducted each discussion following a structured guide that generically asked for barriers and enablers to the sites’ research success and then reviewed commonly identified prehospital research barriers. Notes were taken during each discussion and reviewed for common themes. Themes were reviewed by the project team and sent for comment to all participants. Results. Discussions were held with 25 principal investigators, 9 coordinators, and 7 EMS liaisons. A total of 27 communities were represented in the discussions from 22 different states. The communities had a range of research experience from one prehospital trial to multiple trials. Key barriers were funding, ethics approval, data collection, protocol training and compliance, randomizing and blinding interventions, obtaining patient outcomes, adequate study staffing, and partnering with EMS agencies. Conclusion. This project identified many challenges to EMS research, but they were not insurmountable. Not every community can conduct every prehospital study. Communities should engage in studies that align with their values and resources. Investigators need to develop honest relationships where issues can be openly discussed and the community can collaborate on prehospital research. Learning from those who have overcome challenges may be a key to expanding the quality and quantity of EMS research.

The Pediatric Emergency Care Applied Research Network: a history of multicenter collaboration in the United States.

In this article, we review the history and progress of a large multicenter research network pertaining to emergency medical services for children. We describe the history, organization, infrastructure, and research agenda of the Pediatric Emergency Care Applied Research Network and highlight some of the important accomplishments since its inception. We also describe the network's strategy to grow its research portfolio, train new investigators, and study how to translate new evidence into practice. This strategy ensures not only the sustainability of the network in the future but the growth of research in emergency medical services for children in general.

Description of the 2012 NEMSIS Public-Release Research Dataset

Background. The National Emergency Medical Services Information System (NEMSIS) is a federally funded project designed to standardize emergency medical services (EMS) patient care reporting and facilitate state and national data repositories for the assessment of EMS systems of care. The purpose of this assessment is to characterize the annual NEMSIS 2012 Public-Release Research Dataset, detailing the strengths and limitations associated with use of these data for EMS quality assurance and/or research purposes. Methodology. Using descriptive statistics, we evaluated the dataset completeness (i.e., presence of missing/null values) and dataset content. To assess data generalizability, we compared age distributions to the 2010 National Hospital Ambulatory Medical Care Survey (NHAMCS). Subanalyses were conducted for cardiac arrest- and trauma-related EMS activations to describe their characteristics, treatments, and dispositions. The analysis focuses primarily on 9-1-1 EMS activations resulting in the treatment and transport of a patient, excepting the analysis conducted for out-of-hospital cardiac arrests (OHCA), which includes scene deaths. Results. In 2012, 19,831,189 EMS activations were reported to NEMSIS by 8,439 agencies located in 42 states and territories. Of the 10,733,925 9-1-1 EMS activations reportedly treating and transporting a patient, the majority were attended by a paid EMT-paramedic (82%) employed by a fire-based EMS agency (25%) working in an urban area (53%). 9-1-1 call centers most likely dispatched EMS for a “sick person” (14%), while providers most likely reported pain (26%) as the patient's primary symptom and “traumatic injury” (13%) as the likely cause. NEMSIS data adequately characterize specific patient populations and demonstrate significant similarity to independent distributions of EMS patients (i.e., NHAMCS), yet missing data and use of null values remain prevalent. Conclusions. The annual NEMSIS Public-Release Research Dataset is a valuable resource for evaluating the U.S. EMS activation population and can be used to conduct in-depth descriptions of the care of specific populations. However, the utility of the data are limited until the number of null values can be diminished and reporting becomes universal.

Creating an infrastructure for comparative effectiveness research in emergency medical services.

Emergency medical services (EMS) providers deliver the initial care for millions of people in the United States each year. The Institute of Medicine noted a deficit in research necessary to improve prehospital care, created by the existence of data silos, absence of long-term outcomes, and limited stakeholder engagement in research. This article describes a regional effort to create a high-performing infrastructure in southwestern Pennsylvania addressing these fundamental barriers. Regional EMS records from 33 agencies in January 2011 were linked to hospital-based electronic health records (EHRs) in a single nine-hospital system, with manual review of matches for accuracy. The use of community stakeholder engagement was included to guide scientific inquiry, as well as 2-year follow up for patient-centered outcomes. Local EMS medicine stakeholders emphasized the limits of single-agency EMS research and suggested that studies focus on improving cross-cutting, long-term outcomes. Guided by this input, more than 95% of EMS records (2,675 of 2,800) were linked to hospital-based EHRs. More than 80% of records were linked to 2-year mortality, with more deaths among EMS patients with prehospital hypotension (30.5%) or respiratory distress (19.5%) than chest pain (5.4%) or nonspecific complaints (9.4%). A prehospital comparative effectiveness research infrastructure composed of patient-level EMS data, EHRs at multiple hospitals, long-term outcomes, and community stakeholder perspectives is feasible and may be scalable to larger regions and networks. The lessons learned and barriers identified offer a roadmap to answering community and policy-relevant research questions in prehospital care.

Frequency of Manuscript Publication Following Presentation of EMS Abstracts at National Meetings

Specialized knowledge and a scientific body of literature are the foundation of the recognition of Emergency Medical Services (EMS) as a subspecialty within emergency medicine (EM). Emergency Medical Services research often is presented at national meetings and published in abstract form, but full publication occurs less frequently. Problem The primary goal of the study was to determine the rate at which EMS-related research presented at selected conferences went on to manuscript publication. A secondary goal was the determination of the time to manuscript publication. A cross-sectional study of published abstracts from the 2003-2005 national meetings of the American College of Emergency Physicians (ACEP), Society for Academic Emergency Medicine (SAEM), National Association of EMS Physicians (NAEMSP), Association of Air Medical Services (AAMS), and the National Association of EMS Educators (NAEMSE) was conducted to identify EMS-related abstracts. PubMed (National Center for Biotechnology Information, Bethesda, Maryland USA) was searched using abstract title keywords and authors' names to determine if the study had been published in a PubMed-indexed journal in the time since presentation and abstract publication. Abstracts for the five conferences were reviewed for 2003-2005. Six hundred and thirty-five EMS-related abstracts met the inclusion criteria. The total number of EMS abstracts presented and the percent subsequently published as a manuscript were: SAEM 135, 53.3%; ACEP 128, 48.4%; NAEMSP 282, 42.9%; AAMS 66, 33.3%; and NAEMSE 24, 16.7%. The overall rate of publication was 44.3%. The average time to publication was 22.2 months (SD = 16.5 months, range = 0-94 months). Less than half of EMS abstracts go on to manuscript publication. This may represent missed opportunities for the growth of EMS as a subspecialty.

Pediatric Emergency Medical Services Research

Currently, there is a limited evidence base in prehospital care, especially so in pediatric prehospital care. This is, in part, due to the many obstacles in conducting clinical trials in the prehospital setting requiring added resources and funding to accomplish. The Pediatric Emergency Care Applied Research Network and other organizations have only recently started to encourage the formation of systems to support prehospital research including practical state and national data registries.

Developing a Canadian emergency medical services research agenda: a baseline study of stakeholder opinions

This study forms the first phase in the development of the Canadian National EMS Research Agenda. The purpose was to understand the current state of emergency medical services (EMS) research through the barriers and opportunities perceived by key stakeholders in the Canadian system and to identify the recommendations this group had for moving forward. This qualitative study was conducted in the spring of 2011 using one-on-one semistructured telephone interviews. Purposeful sampling was used to recruit a cross section of EMS research stakeholders, representing a breadth of geographic regions and roles. Data were collected until thematic saturation was reached. A constant comparative approach was used to develop a basic coding framework and identify emerging themes. Twenty stakeholders were invited to participate, and saturation was reached after 13 interviews. Thematic saturation was used to ensure that the findings were grounded in the data. Four major themes were identified: 1) the need for additional research education within EMS; 2) the importance of creating an infrastructure to support pan-Canadian research collaboration; 3) addressing the complexities of involving EMS providers in research; and 4) considerations for a national research agenda. This hypothesis-generating study reveals key areas regarding EMS research in Canada and through the guidance it provides is a first step in the development of a comprehensive national research agenda. Our intention is to collate the identified themes with the results of a larger roundtable discussion and Delphi survey and, in doing so, guide development of a Canadian national EMS research agenda.

Ethics in EMS and Disaster Research

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EMS Providers and Exception from Informed Consent Research: Benefits, Ethics, and Community Consultation

Background. As attention to, and motivation for, emergency medical services (EMS)-related research continues to grow, particularly exception from informed consent (EFIC) research, it is important to understand the thoughts, beliefs, and experiences of EMS providers who are actively engaged in the research. Objective. We explored the attitudes, beliefs, and experiences of EMS providers regarding their involvement in prehospital emergency research, particularly EFIC research. Methods. Using a qualitative design, 24 participants were interviewed including nationally registered paramedics and Virginia-certified emergency medical technicians employed at Richmond Ambulance Authority, the participating EMS agency. At the time of our interviews, the EMS agency was involved in an EFIC trial. Transcribed interview data were coded and analyzed for themes. Findings were presented back to the EMS agency for validation. Results. Overall, there appeared to be support for prehospital emergency research. Participants viewed research as necessary for the advancement of the field of EMS. Improvement in patient care was identified as one of the most important benefits. A number of ethical considerations were identified: individual risk versus public good and consent. The EMS providers in our study were open to working with EMS researchers throughout the community consultation and public disclosure process. Conclusion. The EMS providers in our study valued research and were willing to participate in studies. Support for research was balanced with concerns and challenges regarding the role of providers in the research process.

The Methodology of the Australian Prehospital Outcomes Study of Longitudinal Epidemiology (APOStLE) Project

This paper describes the methodology of a large emergency medical services (EMS) data linkage research project currently under way in the statewide EMS system of New South Wales, Australia. The paper is intended to provide the reader with an understanding of how linkage techniques can be used to facilitate EMS research. This project, the Australian Prehospital Outcomes Study of Longitudinal Epidemiology (APOStLE) Project, links data from six statewide sources (computer-assisted dispatch, EMS patient health care reports, emergency department data, inpatient data, and two death registries) to enable researchers to examine the patient's entire journey through the health care system, from the emergency 0-0-0 call to the emergency department and inpatient setting, through to discharge or death, for approximately 2.6 million patients transported by the Ambulance Service of New South Wales to emergency departments between June 2006 and July 2009. Manual, deterministic, and probabilistic data linkages are described, and potential applications of linked data in EMS research are outlined.

A Qualitative Assessment of Factors That Influence Emergency Medical Services Partnerships in Prehospital Research

Recent efforts to increase emergency medical services (EMS) prehospital research productivity by focusing on reducing systems-related barriers to research participation have had limited effect. The objective of this study was to explore the barriers and motivators to participating in research at the agency and provider levels and to solicit suggestions for improving the success of prehospital research projects. The authors conducted a qualitative exploratory study of EMS personnel using focus group and focused interview methodology. EMS personnel affiliated with the Pediatric Emergency Care Applied Research Network (PECARN) hospitals were selected for participation using a purposive sampling plan. Exploratory questioning identified identified factors that influence participation in research and suggestions for ensuring successful research partnerships. Through iterative coding and analysis, the factors and suggestions that emerged from the data were organized into a behavioral change planning model. Fourteen focus groups were conducted, involving 88 EMS prehospital providers from 11 agencies. Thirty-five in-depth interviews with EMS administrators and researchers were also conducted. This sample was representative of prehospital personnel servicing the PECARN catchment area and was sufficient for analytical saturation. From the transcripts, the authors identified 17 barriers and 12 motivators to EMS personnel participation in research. Central to these data were patient safety, clarity of research purpose, benefits, liability, professionalism, research training, communication with the research team, reputation, administrators' support, and organizational culture. Interviewees also made 29 suggestions for increasing EMS personnel participation in research. During data analysis, the PRECEDE/PROCEED planning model was chosen for behavioral change to organize the data. Important to this model, factors and suggestions were mapped into those that predispose (knowledge, attitudes, and beliefs), reinforce (social support and norms), and/or enable (organizational) the participation in prehospital research. This study identified factors that influence the participation of EMS personnel in research and gathered suggestions for improvement. These findings were organized into the PRECEDE/PROCEED planning model that may help researchers successfully plan, implement, and complete prehospital research projects. The authors provide guidance to improve the research process including directly involving EMS providers throughout, a strong theme that emerged from the data. Future work is needed to determine the validity of this model and to assess if these findings are generalizable across prehospital settings other than those affiliated with PECARN.

More Science for the New Subspecialty

More Science for the New Subspecialty