Have you (or your service) ever tried to do research?

[fiznat]

I've been particularly interested in this lately, and I'm wondering if anyone here as attempted to go down this road with their service and medical control. There is a huge void when it comes to EMS specific research, and I think we could really do some good if there is a push to make science out of our everyday work.

Now, I realize that it isn't an easy thing to do. Of course there are levels of preparation and approval that must be met before a clinical trial is even considered, but beyond some hard work and a little persistence what is actually stopping us? I've got what I think is a good idea for a trial that could be conducted in my area and I'm thinking about approaching my medical control about it. Has anyone here ever tried this before? What kinds of problems did you encounter... any advice?

[CTXMEDIC]

24-Hour Shifts May Endanger Patients and Employees

Austin reports research findings & experience with changing its shifts

EMS Insider

EMS Insider Vol. 34 No. 9

2007 Aug 28

In July 2006, Austin/Travis County (Texas) EMS changed its work schedules after seeing the results of a study in which EMS employees wore sleep/wake monitors on their wrists to determine their alertness levels and “micro sleep” periods (when people sleep briefly while appearing to be awake).

ATCEMS presented some results of that study, which was conducted by Circadian Technologies Inc., a company that works with Harvard Medical School, on a poster at the Pinnacle Forum in St. Petersburg Beach, Fla., Aug. 8. The poster reported that 64% of ATCEMS paramedics found it “difficult” or “very difficult” to stay awake during 24-hour shifts, and 61.8% felt their health would improve with shorter shifts.

According to ATCEMS Assistant Director Chris Callsen, the study revealed some other troubling findings, including that 44% of the medics reported nodding off several times a month during their shifts, 29% said they provide less than optimal patient care near the end of a 24-hour shift, 50% had accidents or near misses due to fatigue and 5% had fallen asleep while driving an ambulance.

Callsen described to a packed room of EMS executives the process and results of ATCEMS changing its busiest stations from 24-hour shifts a year ago.

Most of the service’s 287 paramedics now work two 12-hour shifts at one of ATCEMS’ 12 busiest stations and a 24-shift at one of the 18 “slower” stations. Paramedics must also have at least 10 hours off between each shift.

The paramedics now get to bid their shifts and know what their shifts will be for the next six months. “Previously, people were assigned to shifts and stations, so they got some freedom [with] this change,” Callsen said.

Under the old system, paramedics worked 56 hours a week, and now they work only 48—for the same base pay. This provides a substantial per-hour raise, but cuts the amount of “premium pay” they were getting for overtime.

Outcomes

“This definitely cost some money, and it’s not yet clear if the reduction in errors and litigation will make that up,” Callsen said.

ATCEMS has, however, already noted a decrease in the number of clinical errors reported, a decrease in the seriousness of reported errors and fewer complaints from hospitals. “We’ve had some interesting comments from outside organizations,” he said, “For example, fire department folks ask us why the paramedics are nicer.

“By and large, everyone is pretty happy with this,” he said, noting that ATCEMS lost only two paramedics due to the shift changes and has attracted more female applicants.

“The biggest problems with the shift changes—by a long shot—came from management,” he said, adding that ATCEMS experienced a “significant leadership transition” during the shift change process.

According to Callsen, ATCEMS “underestimated the massive cultural change” it would mean for workers. “We gave them six months lead time, but 12 months would have been better,” he said. ATCEMS also failed to react quickly enough to some initial problems, he said. He advises other services considering shift changes to “take a broad-brush look” at how this change will affect employees, management and the system.

Is it worth it? Callsen stressed that it is. He cited a study that shows that a person’s performance begins falling quickly after 16 hours and reaches that of someone who has a 0.8% blood alcohol level at 22 hours. “Do you really want a paramedic on the street who is [as impaired as if they were] legally drunk?” he asked.

For more information, send an e-mail to chris.callsen@ci.austin.tx.us .

http://www.jems.com/news_and_articles/arti..._Employees.html

[VentMedic]

http://www.researchagenda.org/Agenda/Index.htm

Advice:

Learn how to read medical literature and understand statistical data from a scientific approach. Understand how researchers and critics of medical literature test validity. Many articles are summited to professional journals but very few get published because of flaws in their data collection, methodologies, presentation or computations.

Read medical journals. If you read JEMS, look at the reference section following the article for the medical journal links and read those. If there are no references within or at the end of an article that quotes data, I rarely put much credit to what is written.

www.naemsp.org

has the Prehospital Emergency Care Journal. If you don't have full access through your school or employer, the abstracts will still give you a lot of the information.

http://www.informaworld.com/smpp/title~con...8281~link=cover

There is also a list of presentations in current and ongoing research that will be presented at the NAEMSP conference. This can give one some ideas.

http://www.naemsp.org/documents/2009Accept...tsFinalFile.pdf

[VentMedic]

24-Hour Shifts May Endanger Patients and Employees

http://www.jems.com/news_and_articles/arti..._Employees.html

Good JEMS version of the research but where is the original that explains the methodology and statistical analysis as to how the numbers were derived.

[CTXMEDIC]

Official Press Release

October 16, 2007

Researchers at Brackenridge and Dell Children’s Take Unique Collaboration to the Air with STAR Flight

A new study being conducted by the Seton Family of Hospitals and Austin-Travis County EMS STAR Flight is the first collaboration of its kind and the only study in the country looking at the use of an ultrasound machine for placing IVs in patients during an air medical transport.

http://www.atcems.org/Newsroom/PressReleas...sReleaseID=1270

[fiznat]

http://www.researchagenda.org/Agenda/Index.htm

Advice:

Learn how to read medical literature and understand statistical data from a scientific approach. Understand how researchers and critics of medical literature test validity. Many articles are summited to professional journals but very few get published because of flaws in their data collection, methodologies, presentation or computations.

I agree this is important. You need to understand the language of the field before you attempt to be a part of it. Personally I learned about this stuff in college and have direct experience with performing as well as evaluating scientific research. That was in a different field, though, and I've never been on "this side" of the fence: transforming an idea into an actual trial.

[VentMedic]

Official Press Release

October 16, 2007

Researchers at Brackenridge and Dell Children’s Take Unique Collaboration to the Air with STAR Flight

A new study being conducted by the Seton Family of Hospitals and Austin-Travis County EMS STAR Flight is the first collaboration of its kind and the only study in the country looking at the use of an ultrasound machine for placing IVs in patients during an air medical transport.

http://www.atcems.org/Newsroom/PressReleas...sReleaseID=1270

Where's the actual study link? I want to see how, who, what, when, why and not a warm and fuzzy press release.

I also get suspicious of studies that are probably financed by some drug or equipment manufacturer. That is why I want to read their methology and sampling profile to test validity for myself. Part of the fun is seeing if you can duplicate the results.

From the article:

The $50,000 Sonosite ultrasound machine is already on-board Austin-Travis County STAR Flight. Later this year, the technology will be used in another study that will look at the use of ultrasound to find internal bleeding during transport.

[fiznat]

^^ Thats sorta what I mean. A lot of the stuff that we see purported as "research" in magazines like JEMS and the like are not rigorous studies that hold meaning within the rest of the medical community. I'm talking about performing a real live prospective, randomized double-blind study that adheres to the scientific standards of peer-reviewed literature. Anyone here ever orchestrated something like that before?

[crotchitymedic1986]

A few problems to overcome, which can be done:

1. Figure out before you start, how far you want to take this. If you goal is to get your study published, contact the people who would publish it, and ask about their standards. Then look at the links you have been given about the scientific method, and make sure you understand how it needs to be done. You dont want to do all of that work, just to have it thrown out because you omitted one step in the process.

2. You have to convince your coworkers that it is ok to document and admit the truth on every call that you are studying. Then you have to educate them to the study, how you are gathering data, and how they can help you. For instance, if you are studying ASA administration in MI, then it is important that your medics document the truth when they "forget" to give ASA, give the wrong dosage, or dont give it because of allergy or because the patient already took it but fail to document why they didnt give it. If they are dishonest in their documentation because they know a "study" is going on, and they dont want to get in trouble for messing up your study, then the data gathered is worthless.

3. You have to leave the blinders off. Often times when you start a study, you have a belief about what you think the study will show you, which may steer you to or away from a certain idea or direction, which could jeopardize your study. You have to enter the study as if you are a layperson who has never run an EMS call.

For instance: When I studied "refusals" as a CQI project, it was suggested that we should look to see if minorities were not transported more often than whites. Everyone said, "thats a bunch of BS, no one here is racist." But the initial statistics did show a higher refusal rate among minorities for the same complaint, so we had to dig deeper. When it was all said and done, we found that the issue was economic, not necessarily racial. When you broke the groups down economically, the gap was smaller when you compared poor whites to poor minorities. But still, there was a gap, and the gap improved when medics were made aware of the stats (doesnt mean anyone was a racist).

The same was true when day trucks suggested that the 24-hour crews had more refusals after midnight, which was driving up the numbers. It was true, refusals increased 40+% after midnight. But it would have been easy to just say, "nah, i know these guys, thats not the problem.

I wish you luck, we need alot more "studies". It can only bring "good" to your service and yourself. Nothing would make me happier then to know that the people of this forum launched "5" good EMS studies this year (and them shared them with everyone), even if they are very small scale studies.

[logos]

When I was at the AHA Scientific Sessions I attended a presentation by two paramedics. Their system did a trial of the Zoll Autopulse (or whatever they are calling their newest CPR machine). The two paramedics stood up and presented in a room with many MD and Phd. resuscitation experts and gave an excellent presentation. They even got a couple of questions from the guy who is the "premier" (if you will) resuscitation expert.

Unfortunately, I cannot recall the name of the system.