What research would help us do EMS better?

I was reading the March 2009 issue of Prehospital Emergency Care (for those who don't read it, it is the major peer-review journal devoted to EMS in the US).

I was excited to see, buried amongst the clinical and pseudo-clinical research abstracts, a few studies that might help us run our services better. One was a before and after study of the impact of implementing power stretchers in a large county EMS agency.

We've gt a ton of clinical research going on - the physicians see to that. But how about the non-clinical stuff? How about the questions that we seem to argue about all the time? What topics COULD be cleared up by objective analysis? What topics SHOULD be objectively studied? Do you think that a scientific or academic approach to these issues would help with executives and elected officials?

I'll suggest a couple. What I'd really like is to get a list of dozens more, that we could use to build up enthusiasm for non-clinical research in our BS and MS programs.

Does a dynamic deployment (streetcorner posting) scheme improve response performance? If you take a community and change nothing but the deployment methodology, what happens?

Are there psychological traits that predict success or failure in EMTs and paramedics? Could you give a test and figure out who is wasting their time in EMS and who is not?

Does "more paramedics" in a community mean better or worse patient care? This has both clinical and non-clinical components, but it would be nice to know if "first response paramedics" improve the performance of the EMS system or make it worse? A good answer would save a lot of angst and energy!

OK, what do you think? Operations, human resources, public information, community paramedicine, career ladder, etc., etc. Have at it!


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Comment by MANEA AL-GHANEM on March 30, 2009 at 7:32pm
My name is manea . I'm a new paramedic
I would like to enjoy with you
I need help to get the new things about EMT because I will renew this department in my hospital
Can you give me your advices to build up this department?
Comment by Lisa Bell on February 16, 2009 at 11:58am
Very interesting topic, Skip. You're right -- we need to encourage research related to non-clinical aspects of EMS. At NAEMSP, several of the poster presentations were operational studies, if I remember correctly. Also, in the March issue of JEMS every year, we include the abstracts from the Prehospital Care Research Forum, and several of those focus on operations.

For anyone interested in tackling one of the topics Skip proposes, check out the JEMS EMS Research Grant.
Comment by Duncan Hitchcock on February 14, 2009 at 10:39am
Well, that topic obviously stirred the group the a resounding snore. Although the taser suggestion is appealing.

So, let's try a new non-clinical research topic that could impact our industry. Responding with red lights and sirens. Does it really impact arrival time? On what types of calls. Who decides when they are appropriate? Liabilites associated these decision making policies?
Comment by Duncan Hitchcock on February 13, 2009 at 6:18pm
I'm not sure that our union would go along with it, but there are times I wish I had one.
Comment by Skip Kirkwood on February 13, 2009 at 5:52pm
Duncan, there's a new device out that appears to work great on non-compliant behavior - the TASER!

Comment by Duncan Hitchcock on February 12, 2009 at 7:21pm
Let's get back to research.

Anybody seen anything on correcting non-compliant behaviors?
Comment by Ben Waller on February 12, 2009 at 6:29pm
From my Kitchen Table blog at: http://thekitchentable.firerescue1.com/

"Training is important, but is perfect practice really necessary?"

"Vince Lombardi, the legendary Green Bay Packers coach once famously said "Practice doesn't make perfect. Perfect practice makes perfect."

Old Vince had a good thought but face it, perfect practice on a regular basis is unattainable for most people. More importantly, is perfect practice really important to the fire service?

An unknown author's reply to this was "Practice makes perfect, but nobody's perfect, so screw practice."

Frankly, this is a really bad idea - don't give up before you start, or you have no chance of success except by sheer luck. What we do is much too important to trust only to luck.

I think my brother John has the best solution. He once told me that "Perfect is the enemy of Good Enough."

A little background on this...John is a cardiac anesthesiologist. He has been keeping patients alive during open heart surgery for over three decades. His explanation is that if you try to be perfect in the details of everything you do, you tend to get distracted by details. That often leads to missing an important part of the overall picture. When you're working on a critical process, if you achieve a workable solution to 100% of the problem, you're going to be successful almost all of the time. If you achieve perfection on 90% of the problem, the 10% you don't get to may kill a patient, a firefighter, or someone else. Let's practice until we're good enough at everything we do."

I'd add that there's a reason we call it "practice".
Comment by Tracey Baker on February 11, 2009 at 6:34pm
Practice makes perfect ONLY if you have control over every possible variable that could interfere with success! So the answer is NO
Comment by Lane Doby on February 9, 2009 at 9:32pm
Oh yes. Does "practice makes perfect" ring a bell here?
Comment by Skip Kirkwood on February 9, 2009 at 9:18pm
I haven't seen that recommendation. There are lots of studies out there about airway though. One of the recent interesting ones was by Dr. Henry Wang; the abstract was presented to NAEMSP this year.

He showed that the "magic number" for intubation proficiency was 50 tubes. Apparently after a provider has done 50, the skills is locked in. Before that , success is uncertain.

Interesting, isn't it?
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