Primary Barriers: Funding

Improved monetary compensation for EMS research would help motivate researchers to look at EMS issues. Additional training grants would be useful to encourage the development of experts in both EMS research and a number of areas related to emergency medical systems, such as injury prevention, health services research, and operations management. As the number of well-trained researchers increases, a reliable stream of funding will be needed to support their activities. That stream of funding will necessarily come from a variety of sources. Public funds along with corporate and foundation support will all be needed.

A strong argument can be made that the government should fund the majority of the research into the effectiveness of EMS since EMS is largely paid for with taxpayer monies and since there is almost certainly a pay off in terms of improved efficiency and effectiveness of care. Of the 794 papers identified as likely related to EMS published in 1999 and cited on PubMed, only 30 (3.8%) had at least some support from the United States Public Health Service (PHS). Indeed, 1999 was a record year for PHS support of published EMS research (Figure 3).

Figure 3: Proportion of EMS Research with PHS Funding

Other areas of medicine appear to get more governmental research support than EMS. For example, in 1999 there were 5862 articles with a MeSH heading of breast neoplasms; 892 (15.2%) were PHS supported. There were 1468 articles cited in PubMed in 1999 with a MeSH heading of acquired immunodeficiency syndrome. Of those, 209 (14.2%) were at least partially supported by the PHS. There were 3003 articles with a MeSH heading of myocardial infarction, and 230 (7.7%) of them were PHS supported.

Two diseases with a large impact on both the general health of the public and the design of EMS systems are sudden cardiac arrest and major traumatic injuries. In 1999, there were 13,430 articles with a MeSH heading of heart arrest, of which 828 (6.1%) were PHS supported. There were 4776 articles with a MeSH heading of multiple trauma, and only 86 (1.8%) of those were PHS supported. It is clear that the amount of current funding is inadequate to support real progress in reducing the morbidity and mortality from both of these diseases that kill a large number of Americans each year. The NIH has begun to recognize this fact and held the PULSE Conference in June 2000 to explore ways to increase the funding devoted to attacking the problem of sudden cardiac arrest. A similar initiative is needed to increase funding for research on treatment of injury.

Recommendation 3.

Federal agencies that sponsor research should acknowledge their commitment to EMS research.

· The federal government should increase its commitment and support of EMS research.

· A joint announcement, similar to that issued for EMS Research concerning children (PA-01-044), should be issued to provide opportunities for conducting EMS research under the sponsorship of a group of Federal agencies and to broadly describe the areas in which research is warranted. Each sponsoring agency should delineate and prioritize specific areas of interest and provide detailed information regarding application upon request.

· The number of fully federally funded controlled clinical trials conducted in the EMS setting should increase by 25% each year for five years beginning in FY 2003.

EMS researchers must also begin to compete for funding that is not specifically earmarked for prehospital care. Because EMS has the potential to provide services to individuals experiencing almost every disease process, the pool of appropriate funding sources may be quite large.

The federal government should not be the only organization funding EMS research. Charitable foundations often offer unique and flexible funding, some of which should be dedicated to EMS research. State EMS lead agencies traditionally have not performed EMS research, but they should develop a serious commitment to improve patient care based upon evidence generated by high quality research. Ideally, they should collaborate with at least one academic institution with expertise in EMS research. This collaboration will give state regulators, provider agencies, and EMS professionals access to individuals with expertise regarding grant applications and local research related issues. This academic collaborator should also offer guidance to the state lead agency on EMS research policies.

Recommendation 4.

States, corporations, and charitable foundations should be encouraged to support EMS research.

· State lead EMS agencies should promote prehospital research and facilitate the development of relationships and resources necessary for such studies.

· Corporations and charitable foundations should provide funds for EMS related research.

To successfully compete for both public and private funding, whether earmarked for EMS or not, it will be important for the specialty of EMS to develop a cadre of qualified peer reviewers for granting agencies. As more researchers with EMS backgrounds gain experience with major granting agencies, they will be selected as peer reviewers. This will help facilitate EMS research in the long run as these qualified reviewers will be able to educate other members of grant application review committees about the importance of EMS research programs. A full description of the process of peer review is available on the NIH web site at http://www.drg.nih.gov/review/peerrev.htm.