Article, Emergency Medicine

The importance of developing global emergency medicine research network

a b s t r a c t

Despite the fact that emergency care can impact health of populations, the global epidemiology of emergencies in children and adults is unknown and substantial variation exists in emergency infrastructure among different na- tions, especially among the low and middle income countries. Various research networks which are etiology spe- cific or subspecialty specific, including emergency care based networks have positively impacted the health of populations. However, emergency departments (ED) in low and middle income counties are underrepresented in most international networks. Creation of a global ED based research network will help generate generalizable evidence that can then be translated into locally relevant Evidence-based guidelines, nurture future researchers in emergency medicine, standardize training/education and improve patient outcomes by reducing variation in clinical care.

(C) 2018

Emergency care extends from pre-hospital settings to the emer- gency department (ED) and defined as a system designed to organize “personnel, facilities, and equipment for the effective and coordinated delivery of health-care services” to individuals and populations who are acutely ill or injured, whether surgical, medical or as a result of largescale man-made or natural disasters [1,2]. EDs, an integral part of healthcare systems worldwide, provide vital, uninterrupted, and uni- versal Access to healthcare for all patients. EDs are the first point of con- tact and often serve as a safety net for the disadvantaged. Emergency medicine is increasingly recognized as an independent medical spe- cialty globally, although, primarily in developed countries, with stan- dardized curricula and comprehensive training [3-5]. However, there is substantial variation in the organization of emergency services, re- source allocation, and provider training, all of which negatively impact the quality of care and patient outcomes across the world.

? This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

* Corresponding author at: Department of Emergency Medicine, University of Michigan, 1540 E. Hospital Drive, CW 2-737, Ann Arbor, MI 48109-4260, USA.

E-mail addresses: [email protected] (P. Mahajan), [email protected] (T. Visclosky), [email protected] (N. Kuppermann), [email protected] (R. Neumar).

Inattention to research in emergency medical services globally has resulted in a scarcity of evidence necessary to guide aspects of emer- gency care that could be locally applicable [6]. Data on ED-based patient outcomes is available for higher-income countries, but epidemiology of ED visits globally is unknown, especially in lower- and middle-income Countries (LMICs) [7]. The Global Emergency Medicine Think Tank has identified limited numbers of trained personnel, non-standardized data collection, ethical constraints and insufficient funding as major bar- riers to performing research in LMICs [7], all of which must be addressed systematically. There is an urgent need for current data on emergency Disease burdens and common taxonomies that can be used to compare different populations seeking and receiving emergency care in order to develop global evaluation metrics [7,8].

Many of these barriers have been overcome in other medical special- ties through the creation of local and international health research net- works [9]. The Global Health Advocacy and Policy Project defines such networks as “webs of individuals and organizations linked by a shared concern” that serve in critical “agenda-setting and policy development roles, particularly by influencing how problems and solutions are un- derstood and by recruiting new actors to address the issues that concern them.” [10] The World Health Organization’s World Health Report, called for research networks to enhance population health, equity, and development [11].

https://doi.org/10.1016/j.ajem.2018.11.032 0735-6757/(C) 2018

P. Mahajan et al. / American Journal of Emergency Medicine 37 (2019) 744745 745

The ability to impact emergency care by research networks is sub- stantial as evidenced by the impact of the research generated and im- plemented by U.S. based networks such as Strategies to Innovate Emergency Care Clinical Trial Network (SIREN) and Pediatric Emer- gency Care Applied Research Network (PECARN) and international net- works such as the Pan Asian Resuscitation Outcome Registry (PAROS) and the Pediatric emergency research Networks (PERN) [12-15].

EDs in LMICs are underrepresented in most international networks. However, the RIDEPLA pediatric emergency research network in Argentina and Uruguay, is one such network, but is challenged by fewer financial resources than its counterparts in North America, Europe, and Australia, New Zealand [16]. Development of an ED re- search network involving LMICs will require cross-disciplinary collabo- ration between emergency care providers including physicians, nurses and paramedics, scientists, administrators, and policy experts [17]. As a first step, pertinent stakeholders need to convene in a global forum to draft a mission statement and identify experts and academic institu- tions in participating countries to coordinate collective efforts to high- light the need for emergency collaborative research. Global in-person summits could help establish country-specific and common Research priorities, and advocacy strategies to secure funding from local and global agencies public and private (philanthropic) sources. To develop the next generation of global emergency medicine investigators, robust mentoring programs on various research methods, data analyses, good clinical practices and ethical principles will need to be an integral part of such a network [17]. Additionally, data coordinating centers will be essential and serve as central repositories to ensure Data quality and uniformity. A Global ED-research network should demonstrate the abil- ity to conduct retrospective and prospective studies with reliable, valid data and publish their findings in emergency and non-emergency, peer reviewed journals and use innovative dissemination techniques such as use of educational websites (e.g. Academic Life In Emergency Medicine www.aliem.com or Twitter) [18,19]. Such efforts are imperative as it will inspire policymakers to include emergency medicine research, and the potential network, in national healthcare agendas.

A global emergency medicine research network must remain patient-centric and adhere to fundamental ethical principles. This can be complicated if countries, regions lack formal ethics committees that meet international guidelines. Building a model of using data to im- prove patient care which impacts the health of populations in all regions of the globe should be the mission of this network. The steps towards advancement for harnessing of clinical data will be incremental and may first involve determining feasibility in collecting baseline data pro- spectively using electronic data capture via secure web and or mobile applications, given that many LMICS countries already have robust mo- bile technology infrastructure. The long term goal should be a collabora- tive partnership between high income countries and LMICs to gather, mine, and use data to generate evidence, disseminate knowledge and implement changes to improve local emergency health systems. Al- though few, some examples of such collaborations have already re- sulted in some joint statements or Consensus guidelines for condition- specific evaluation and management [8] and for development of train- ing programs [17,18]. It is also important to seek and incorporate inno- vative technologies that might be cost effective, especially in resource constraint settings.

The ultimate goal of an emergency research network is to improve the care of acutely ill and injured patients, build a body of knowledge by collecting the necessary data to guide population health efforts and nurture researchers in emergency care. Indeed, the potential benefits,

i.e. improving care of individuals, communities and nations far exceed

the substantial challenges involved in developing successful research networks.

Conflicts of interest

The authors have no conflicts of interest relevant to this article to disclose.

Acknowledgements

The authors would like to thank the following individuals for their work on this project: Elizabeth Duffy and Apoorva Belle.

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