Emergency Medicine

PREHOSPITAL AND TRANSPORT MEDICINE

Brief Description

The prehospital research program is dedicated to the advancement of the science of emergency health care delivery in the out-of-hospital setting. Out-of-hospital emergency care delivery is a conjoint municipally and provincially funded system providing care to millions of patients a year and requires multiple emergency medical services (EMS) systems and thousands of providers throughout the Province of Ontario. This research program conducts emergency medical services systems research and has the ability and capacity to conduct large clinical trials. Current research projects include: the evaluation of policy and operational strategies for emergency health care delivery and transport medicine; evaluating educational strategies and innovations and clinical decision support; the development and validation of clinical decision rules and outcome measures; implementing trials to evaluate the out of hospital efficacy and effectiveness of devices and drugs; use of administrative data sets to evaluate emergency health services, including EMS.

Principal Investigators

Recent Original Research Publications

Dorian P, Cass D, Schwartz B, Cooper R, Gelaznikas R, Barr, A.  Amiodarone as compared with lidocaine for shock resistant ventricular fibrillation. N Engl J Med 346:884-90, 2002.

Morrison LJ, Verbeek PR, McDonald A, Sawadsky B. A meta-analysis of prehospital thrombolysis and the effect on mortality in acute myocardial infarction.  JAMA 283:2686-2692, 2000.

Schull MJ, Szalai JP, Schwartz B, Redelmeier DA. Emergency department overcrowding following systematic hospital restructuring: trends at twenty hospitals over ten years. Acad Emerg Med 8:103-104, 2001.

Schull MJ, Morrison LJ, Vermeulen M, Redelmeier DA. Emergency department overcrowding and ambulance transport delays for patients with chest pain. CMAJ (in press).

Verbeek PR, Vermeulen MJ, Ali FH, Messenger DW, Summers J, Morrison LJ. Derivation of a termination-of-resuscitation guideline for emergency medical technicians using automated external defibrillators.  Acad Emerg Med 9:671-678, 2002.

Future Directions

The prehospital research program is working with a consortium of academic centres, EMS operators, municipal and provincial government representatives, and the Institute of Clinical and Evaluative Sciences to create a Provincial EMS data warehouse, management, and analysis unit.  This consortium would provide the first large administrative data set for land and air EMS in North America (1.3 million calls per annum). This initiative has the potential to contribute to operational, research and quality assurance outcome measures and evaluation, in addition to administrative data set analyses that have never been described in the literature; and to unite the Provincial EMS health care delivery system in large research studies. The dedicated EMS human patient simulator and a strong affiliation with the Centre for Research in Education provides an opportunity to conduct important educational and decision support research projects that will ultimately change the certification and maintenance of competence process for the paramedic provider.

EMERGENCY MEDICINE EDUCATION

Brief Description

This is a multicentre program to improve the delivery and evaluation of educational initiatives during clinical emergency medicine rotations, and to develop innovative education strategies for emergency medicine trainees, based on sound curriculum development. Participants include clinical faculty, residents, undergraduate medical students and professional educators. Our program makes use of strong liaisons between clinical departments, simulation centres and the Centre for Research in Education (CRE). Areas of current research include evaluation of trainee performance; evaluation of candidate applications; use of simulators in emergency medicine education; use of disaster medicine and emergency medicine mock scenarios; curriculum development in health care advocacy, ultrasonography, inner city health, and procedures in emergency medicine; and educational development to improve clinical teaching in the emergency department.  A large component of the program centers on development and evaluation of paramedic training initiatives. Practical application of our research efforts have resulted in new workshops in emergency medicine simulation, highly reliable interview and application package assessment tools, large scale disaster exercises, faculty development workshops, and Royal College of Physicians and Surgeons of Ontario academic workshops on curriculum design.

Principal Investigators

Recent Original Research Publications

Bandiera G, Regehr G. A structured application assessment instrument is a reliable tool for assessing applications to Canadian postgraduate training programs in Emergency Medicine. Acad Emerg Med 10:594-598, 2003.

Bandiera G, Morrison LJ, Regehr G. Predictive validity of the global assessment form used in a final- year undergraduate rotation in emergency medicine. Acad Emerg Med 9:889-895, 2002.

Penciner, R. Clinical teaching in a busy emergency department: strategies for success. Can J Emerg Med 4:286-288, 2002.

Leblanc V, Brooks R, Norman LR, Regehr G. Believing is seeing: the influence of a diagnostic hypothesis on the interpretation of clinical features. Acad. Med 77(10S):77-79, 2002.

Farion K, Morrison LJ. Redefining emergency medicine procedures: Canadian competence and frequency survey. Acad Emer Med 8:731-738, 2001.

Future Directions

The program seeks to further expand research into simulators in emergency medicine, effective teaching strategies during clinical shifts, innovative curriculum development for undergraduate and postgraduate emergency medicine training, and implementation of paramedic training initiatives. Areas of specific interest include perceptions of teaching by trainees and faculty, psychometric properties of oral examinations, inner-city health curricula, simulation evaluation in prehospital care, and emergency medicine procedural skills. Infrastructure developments include augmentation of faculty, recruitment of interested undergraduate and postgraduate trainees, and the development of an educational fellowship program in emergency medicine education.