How to do Prehospital Research
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Transcript of How to do Prehospital Research
SMACC DublinMarius Rehn@DrRehnNorwegian Air Ambulance FoundationLondon´s Air AmbulanceUniversity of Stavanger
How to do pre-hospital research
Painfully complicated; Publications Practical work; Lonely Hard work: Clinical-Academical
Patient pathophysiology-strategies of care Care: Influence outcome the most
Evidence-based: PH-practice Critically appraising our practice: Improvement/harm/cost-effectiveness
Cannot extrapolate in-hospital evidence-field Pre-hospital environment: Kit, diagnostic, crew
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7 Deaths per year (millions)
Injury HIV/AIDS, TB and Malaria
Figure 1:
The scale of the problem Injury deaths compared to other leading causes of mortality.
The magnitude and causes of injuriesEvery day the lives of over 15 000 people are cut short as a result of an injury. Among
the causes of injury are acts of violence against others or oneself, road traffic crashes,
burns, drowning, falls, and poisonings. The deaths caused by injuries have an
immeasurable impact on the families and communities affected, whose lives are often
changed irrevocably by these tragedies.
Injuries and violence have been neglected from the global health agenda for many
years, despite being predictable and largely preventable. Evidence from many
countries shows that dramatic successes in preventing injuries and violence can be
achieved through concerted efforts that involve, but are not limited to, the health
sector. The international community needs to work with governments and civil society
around the world to implement these proven measures and reduce the unnecessary
loss of life that occurs each day as a result of injuries and violence.
Injuries are a global public health problem About 5.8 million people die each year as a result of injuries. This accounts for 10%
of the world’s deaths, 32% more than the number of fatalities that result from malaria,
tuberculosis, and HIV/AIDS combined (see Figure 1).
Approximately a quarter of the 5.8 million deaths from injuries are the result of suicide
and homicide, while road traffic injuries account for another quarter. Other main causes
of death from injuries are falls, drowning, burns, poisoning and war (see Figure 2).
Every 5 seconds
someone in the world dies as a result of
an injury
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Injuries and violence: The facts. WHO; 2010
10% deaths PH-research is underfunded Quality of evidence is weak How can you contribute? Components
5.8
Transfusionpaperwork
Golden hour box™
4 emergency units of O Rh negative packed red blood cells
Sealed by blood bank
Maintain steady state temperature of 2-4C for 48-72 hours
Data logger
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Unit of packedred blood cells
Battery pack
Blood warmergiving set
Blood giving set
3-way tap and 50 ml syringefor intraosseous administration
Patient
Blood warmerheating element
Blood giving set
Relevant - patient oriented questions “So what” filter
Hospital - Street Test: Feasibility and impact on outcome
PH: injuries evolving, classic features; “fully established disease” Indications/contraindications Diagnostic test accuracy
Before embark: Recent and seminal pieces Systemic review: identification, data extraction, quality appraisal, meta-analysis
Crux: Study methodology Hierarchy of evidence: Expert opinion-RCT Aim high: not dismiss Case series: High volume Observational studies: Causation / Association
RCT: Systematic skewness Not impossible Solid framework: Funding, data collection, experienced researcher, commitment PH-cancer care: Systematic hard work Increase level of evidence
Statistical models Observational: Regression Not feasible: Mathematicians Statisticians Selective publication: positive studies Negative studies
Science lead to change: Communicated SMACC: FOAM vs conservative scientific establishment Editorial peer review + Unmoderated debate Merge science with education; Twitter
Clinician, relevant hypotheses, designer of research methods, analyser of data, interpreter of results, current literature, decent writer - communicator of science, 140 characters Fascinating, vital, never completely mastered
Evidence-based medicine Preserve limited resources Seek evidence it is lacking Dichotomy Know and Do Quest: Critical care without walls