Emergency Medicine Research: Opportunities for just about anything!

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Emergency Medicine Research Opportunities for
just about anything!
Prof David Taylor Director of Emergency and
General Medicine Research, Austin Health
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What is Emergency Medicine?

• the management of any medical condition
  presenting from the community
• breadth and depth
• multi-disciplinary
• interface between the community and inpatient
  care

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What is Emergency Medicine?

• the management of any medical condition
  presenting from the community
• breadth and depth
• multi-disciplinary
• interface between the community and inpatient
  care

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The ED interface inpatient care
Community providers
General Practice
Nursing homes
Ambulance
Retrieval

• Emergency Department

Diagnostics
Education
Inpatient services
Outpatient services
Admin
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The paradigm shift

• 1980 triage, quick fix or referral

2010 triage, extended management /-
referral
2012 triage, quick fix or referral
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Extended management

• thrombolysis
• procedural sedation
• resuscitation
• fracture/dislocation
• point of care testing
• multi-disciplinary triage

• nurse practitioners
• pharmacists
• primary care physio
• nurse analgesia
• care coordination
• short stay units
• community outreach

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Opportunities for ED Research

• lots of patients
• lots of diseases
• lots of potential collaborators
• evolving paradigm, evolving research questions
• considerable interest
• students, ACEM training requirement
• extra dimension to clinical work

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Collaborations

• Austin Departments
• General Medicine
• Clinical Pharmacology
• Infectious Diseases
• Respiratory Medicine
• Microbiology
• Physiotherapy
• Intensive Care
• Victorian Poisons Info Centre

• Universities
• Melbourne
• Monash
• La Trobe
• RMIT
• Uni QLD
• Uni WA
• Diver Alert Network
• (SE-Asia Pacific)

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Collaborations Hospitals

• Royal Melbourne
• St Vincents
• Box Hill
• Alfred
• Northern
• Epworth
• Royal Adelaide (SA)
• Liverpool (NSW)
• Royal Brisbane Womens (QLD)
• Redcliffe (QLD)
• Prince Charles (QLD)
• et al.

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Difficulties of ED Research

• clinical service pressures
• lack of track record and expertise
• lack of infrastructure and resources
• short patient interaction time
• patients are ill, by definition
• informed consent
• incentive to follow up

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Funding

• beg, borrow and stealshoestrings
• Competitive grants
• NHMRC
• ARC
• RMIT
• ACEM
• Philanthropic organizations
• AMS student supervision
• Prizes Awards

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What sort of studies do we undertake?

• Observational
• Process evaluation
• Epidemiological
• Clinical trials
• RCTs
• intervention

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Studies Observational

• Procedural sedation practices and factors
  associated with adverse events
• Complementary and Alternative Medicine use among
  ED patients taking warfarin
• Mobile phone use by Melbourne drivers

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Studies Process Evaluation

• Primary Contact Physiotherapy Service in the
  Emergency Department
• Nurse-initiated Analgesia for Emergency
  Department patients
• Utility of abdominal Xrays among emergency
  department patients

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Studies Epidemiology

• Chemical eye injuries reported to the Victorian
  Poisons Information Centre
• Absenteeism among public hospital staff
• Paediatric dog bite injuries in the domestic
  setting

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Studies Clinical Trials

• IV droperidol and olanzapine as adjuncts to
  midazolam for the acutely agitated patient
  a
  multi-centre, randomized, double blind controlled
  trial
• Tropisetron vs metoclopramide for nausea and
  vomiting a randomised, double blind, clinical
  trial
• Fascia iliaca block versus femoral nerve block
  for femoral neck fractures a randomized,
  clinical trial

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Studies the past

• Scuba diving
• Surfing
• Mobile phone use
• Weather and the ED
• Animal bites
• Marine animal injuries
• Obesity
• Health Smart cards

• Fungi
• Alcohol use
• Complementary meds
• Complaints
• Psych health
• Advance directives
• Self harm
• Facsimile

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The Problem

• Wide range of
• topics
• presentation venues
• publication options
• funding sources
• Master of nothing !!
• funding
• career

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The Future Infrastructure

• Personnel
• Research assistant/nurse
• Research fellowship
• MD, PhD, BMedSci (AMS) scholars
• Facilities
• Dedicated office space
• Computing, statistical software etc
• Collaboration
• within the Austin
• other EDs, universities, institutions

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ED Research The next frontier?

• relatively new frontier
• one of a number
• immunology
• genetics
• imaging
• oncology
• ED collaborations
• ACEM clinical trials group
• NHMRC track record

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Your research

• interesting
• useful
• themed for track record
• publish or perish
• fun!!