Foundation Board approves funding for three grants focused in EMS research

 

The MedEvac Foundation International is pleased to award funding to three grants for 2016. The Foundation has approved funding for Phase II of Dr. Daniel Patterson’s fatigue study. Phase I was also supported financially by the Foundation. In it, one hundred ground paramedics, flight paramedics, flight nurses, emergency room nurses, and several emergency physicians were enrolled to participate over a 90-day study period. Dr. Patterson and his team used text-messages to record and report feelings of fatigue and sleepiness during shift work. The application, known as the SleepTrackTXT tool, uses text-messaging to query EMS clinicians in real-time at the beginning, during, and end of scheduled shifts. Participants in the intervention group received strategy messages in real-time to report levels of fatigue, sleepiness, or difficulty concentrating during their shift. The Phase I findings are published in The American Journal of Industrial Medicine, and revealed that a simple intervention of prompting EMS clinicians with fatigue to take a nap or drink caffeine leads to reductions in overall fatigue, sleepiness, and difficulty with concentration. Phase II of this study will provide a novel mechanism for fatigue risk management through improved real-time surveillance and targeted, individualized, and tailored interventions.

Phase I and II will have a significant impact on the medical transport community. The future of fatigue risk management is in the use of real-time monitoring. Knowledge of fatigued clinical providers will allow for improved strategies, such as prompting the provider to use caffeine or to take a nap. Data from the Phase II study may demonstrate how agencies can integrate this type of technology and protocol as part of a larger fatigue risk management system that includes brief rest periods or other strategies. This research may also lead to the technology being used to proactively identify HEMS clinicians with poor sleep health and offer them resources to mitigate fatigue related risk and improve their quality of life.

“The safety of prehospital clinicians and their patients is the highest priority for EMS systems nationwide,” states Dr. Patterson of Carolinas Healthcare System. “Despite this priority, there is a tremendous deficit in research of EMS operations that expose common safety hazards and effective interventions for safety improvement. The MedEvac Foundation has been a leader in funding novel research with the potential for future funding and high impact. Their support and investment is vital given the limited availability of federal and foundation funding for EMS research.”

The Foundation will also support the Ground and Air Medical qUality in Transport (GAMUT) Quality Improvement Collaboration, with Dr. Michael Bigham as Principal Investigator. Transport medicine has matured into a specialized discipline. Although equipment, patient assessment methods, therapeutic interventions, protocols, aircraft/vehicle technology, and professional training have advanced significantly, related initiatives in medical transport quality care research has lagged behind. In 2011, six pediatric-neonatal critical care transport programs in Ohio addressed this need by forming the “Ohio Neonatal/Pediatric Transport Quality Collaborative.” This collaborative effort was the genesis of an ambitious project: defining quality metrics in transport and forming a collaborative to create transport-related quality improvement measures. Further development led to creation of the Ground and Air Medical qUality in Transport (GAMUT) Quality Improvement Collaboration and quality metric database. The GAMUT quality metrics project and its database now include more than one hundred participating medical transport programs and more than 150,000 patient contacts across all age groups. Its rapid acceptance by the transport community attests to the project’s benefits.

The MedEvac Foundation grant funding is meant to further develop and implement a GAMUT database graphical dashboard user interface. This will facilitate transport teams on-demand access to their data, including automated performance analyses using visual statistical process control charts. The grant will also fund development and implementation of training for GAMUT participant teams to learn fundamental quality improvement methodologies and maximize their capability to use GAMUT database resources. The expected outcome of this project is a sustainable medical transport registry to benchmark quality indicators across multiple institutions and identify high performing transport programs. The work will result in a significant positive impact, industry wide, because it will be the first to define transport standards and best practices to improve the care and outcomes of all transport patients.

The final project funded in this year’s MedEvac Foundation International grant cycle is a study on blood warming devices conducted by Dr. Andrew Weatherall of CareFlight in Australia. CareFlight operates a Helicopter Emergency Rapid Response Trauma Service (HERRT) to rapidly deploy a physician/ paramedic team to the site of an accident. The team carries two units of packed red blood cells (PRBCs) stored in a regulated cool box at 4 degrees Celsius. Previous studies show infusion of cold crystalloid fluids can cause a drop in core body temperature of approximately 1.3 degrees Celsius. This is potentially harmful as trauma patients are at risk of hypothermia, with studies showing 50% of major trauma patients presenting to the emergency department have a core temperature of less than 36 degrees Celsius. Post-traumatic hypothermia is an independent predictor of mortality in retrospective and prospective studies. Commercial warming devices are already in use in the market, but formal assessment of these devices in real world conditions is lacking. By replicating prehospital flow rates and assessing how these devices provide warmed blood product, clinicians will be better able to judge device performance and the ability to prevent resuscitation-related hypothermia. The study will also assess device safety, including red cell hemolysis, to ensure such a device does not compromise patient safety as it performs its role in warming infused blood products.

“The Foundation invests in research that helps the medical transport community become more efficient in the delivery of safe, quality air medical and critical care ground transport to all critically ill or injured patients. These studies are vital to improving work place environments, the safety of our industry’s professionals, while addressing every patient-in-need, raising the patient care to an optimal level,” states Rick Sherlock, MedEvac Foundation International President & CEO.