999 EMS Research Forum

1
999 EMS Research Forum

• Prioritisation of topics for research in
  prehospital care

999emsrf_at_swansea.ac.uk
2

• The 999 EMS Research Forum is a partnership of
  academics, clinicians, prehospital care
  practitioners and managers, formed in 1999, whose
  aim is to encourage, promote and disseminate
  research and evidence based policy and practice
  in 999 healthcare.

999emsrf_at_swansea.ac.uk
3
Review of research in prehospital care for DH

• Objectives
• identify and review reviews
• identify the limitations and strengths of
  existing pre-hospital care evidence
• identify ongoing research and planned delivery of
  results
• match existing research evidence with current
  policy developments to identify gaps
• identify priority areas for further research,
  with associated timescales and type of research
  required

999emsrf_at_swansea.ac.uk
4
Sources of policy documents guidelines

• Emergency Care policy documents published by the
  Dept. of Health at http//www.dh.gov.uk/en/Policy
  andguidance/Organisationpolicy/Emergencycare/index
  .htm
• Cochrane Prehospital and Emergency Health Field
  Website
• NHS National Library for Health Emergency Care
  Specialist Library
• Emergency Care web pages at the Health Services
  Research Institute of Warwick University
• Service Delivery Organisation webpages at
  http//www.sdo.lshtm.ac.uk
• National Institute for Clinical Excellence
  guidance
• National Service Frameworks
• References of policy documents obtained
• Joint Royal Colleges Ambulance Liaison Committee
  (JRCALC) website (key points related to treatment
  included)

999emsrf_at_swansea.ac.uk
5
Sources of prehospital research literature

• PubMed
• Web of Science
• The Cochrane Library
• HMIC (Health Management Information Consortium)
• DUETs (Database of Uncertainties about the
  Effects of Treatment)
• The National Research Register
• HTA research publications list
• Ongoing and recently completed research listed on
  the HTA, SDO and Cochrane Library websites

999emsrf_at_swansea.ac.uk
6
Drafting of list for prioritisation

• Table of policy matched to evidence
• Gaps highlighted
• Combined with list of topics of research from
  Ambex 2006 conference session
• Circulated to wide group to identify omissions
  (done)
• Further circulation (two stages) planned to
  achieve ranking of
• Topic areas
• questions

999emsrf_at_swansea.ac.uk
7
Topic area examples

• Access call handling and despatch
• Rise in demand
• Pre-999 call
• Emergency call management
• Access 999 emergency response
• Management and operations
• Organisation of EMS
• Workforce
• Service users
• Information
• Services - Alternatives to ambulance/AE
• Direct referral to specialist care
• Management outside AE
• Helicopters
• Treatments - Clinical interventions
• Children, trauma, airways, diabetes, stroke,
  chest pain, pain, seizures, nausea

8
Questions

• Rise in demand
• Understanding the causes of the rise in demand
  for emergency calls
• epidemiology of the rise in demand for emergency
  calls
• developing interventions to manage the increase
• Understanding how services are being used and
  variations and inequalities in access, service
  user decision making
• Effects of publicity campaigns for appropriate
  use of 999 service

999emsrf_at_swansea.ac.uk
9
Questions

• Workforce
• Skills and competencies in the EMS workforce
• Training of paramedics in primary care skills
• PTSD in ambulance personnel prevalence and
  effectiveness of interventions
• workforce safety - hazards in community response

999emsrf_at_swansea.ac.uk
10
Questions

• Trauma management
• MAST suit for subgroups of patients
• Investigation into variations in the treatment
  and management of ankle fractures
• Use of spinal boards (Literature review)
• Airway management
• Intravenous fluid administration

999emsrf_at_swansea.ac.uk
11
Delphi circulation list

• British Paramedic Association Research Committee
• JRCALC Committee
• Ambulance service medical/clinical directors
  (DOCCs)
• Ambulance service RD leads
• International representatives from Europe and USA
  
• Ambulance service trust chief executive
• Operations director of an ambulance service trust
  
• Faculty of Prehospital Care Research Committee
• INVOLVE and/or the Patients Forum
• College of Emergency Medicine
• BASICS the British Association for Immediate Care
• Royal College of GPs
• 999 EMS Research Forum Board
• Thematic Research network for emergency and
  UnScheduled Treatment (TRUST) Board members

If you want to be included contact 999emsrf_at_swans
ea.ac.uk
12
Method

• Delphi exercise with 2 rounds
• Every stakeholder asked to score questions AND
  topics
• Score 1 not important to 9 most important
• Questions and topics ranked by scores
• Re-circulated and re-scored

Whats important?
13
Whats important?

• Related to VoI
• Based on
• Burden of disease
• Size of patient group
• Severity of condition
• Uncertainty about best care, etc
• No evidence, weak evidence, etc
• Potential (therapeutic) impact
• Size of possible effect
• Cost

14
Dissemination

• DH
• Publication
• Use to help funding bodies decide on priorities

New funding opportunities - CSR uplift to
1.7Bn - New programmes in translational
medicine, public health, methods, e-health -
substantial expansion for HTA, SDO, etc