Research and Professional Education in Emergency Medical Services

Emergency Medical Services (EMS) is a critical component in the delivery of quality healthcare services. Being the first line of professionals to respond and evacuate patients to hospitals, paramedics play a major role in influencing the short term and long term health outcomes the clients with traumatic injuries. In this case, there is need to continuously empower paramedics them with up to date skills and knowledge, to enhance their competence in the profession, through continuous professional education and research in emergency medical services. However, lack of adequate repository of knowledge such as books and scholarly research studies in the field is a major hindrance. This study sought to examine the trend in EMS research, by investigating the scholarly research studies published in the filed in the last 10 years. An electronic search was conducted in the various databases to monitor the number of published scholarly research articles in 13 countries across the world. The study found that although there has been a gradual increase in the number of published research studies during the period of review, the number is so far below the required standards. This indicates low interest in continuous professional development of EMS through research, a situation that hinders delivery of improved services in the field.


Background
Emergency Medical Service (EMS) is one of the critical components of healthcare system, which is normally involved in the rescue, stabilization and transportation of trauma patients to medical institutions for treatment [5].The demand for EMS in both developing and developed countries has been on an increasing trend, due to ever increasing incidences of automobile accidents, violence and disasters.United States has 850,000 emergency medical services providers actively involved in providing pre hospital care services to about 20,000 emergencies that occur annually in the country [1].However, professional development of paramedics to enhance their ability to deliver improved quality pre-hospital services has emerged as a major area deserving attention from all stakeholders.
Being a paramedic with all levels of academic background are infrequently to spend a lot of time in researching and writing for the EMS industry, generally, paramedics are depending on routine Continuing Medical Education (CME) and recertification as their regular professional learning.As a matter of fact, many advances in professional education are intimately connected to the research for solutions to practical problems [6] Promoting continuous learning and research has been identified as one of the key approaches of enhancing competence in EMS and healthcare system at large [3].This realization has been brought about by need to have the entire healthcare system adapt and adequately address the emerging trends and demands of healthcare services in the 21 st century.
These include the need to improve the quality and outcomes of patient care, providing universal and affordable healthcare and application of emerging medical technologies [3].
Empirical research evidence indicates that continuous learning and professional development among paramedics empowers them with skills that enhance recovery outcomes of emergency patients and in generation of new knowledge crucial to advancement of the profession [1,2].A research study by Guy and Brachet [2] found that paramedics that trained on the use of pre-hospital Advanced Life Support (ALS) reported a decline in the seriousness of injuries and mortality of trauma patients within 24 hours.Moreover, ALS intervention was found to enhance recovery from multiple traumatic injuries [2].
Evidence based research studies on delivery of EMS services in remote areas have also indicated an improvement in survival rates for trauma patients after administration of on scene interventions in Ireland [3] and prediction in occurrence rate for prehospital cardiac arrest in Hong Kong [4].All of these studies underline the research importance of continuous professional development of paramedics.
A study investigating the effects of continuous professional development on paramedics indicated found that the learners reported significant benefits, including gaining new knowledge and updating their skills and introducing new evidence based practices into the profession.Paramedics are exposed to various occupational hazards, which includes contact with body fluids disaster scenes, risk of falling objects and exposure to violence [2].A combination of these factors makes EMS one of the careers with lowest staff retention rates.The challenging working environment has over the years been attributed to playing a significant role in undermining establishment of a learning culture in the EMS [1].This research study sought to investigate the number of scholarly research studies published in paramedics and EMS.

Methodology
To investigate research development in paramedics and emergency services an extensive electronic search was conducted in various research databases across the world.The search sought to establish the number of scholarly studies in paramedics and emergency medical services from 1997 to 2016 in 13 countries.The countries included United States, United Kingdom, Germany, Canada, France, Hong Kong, India, China, Japan, South Korea, Singapore, Australia and Taiwan. .To identify relevant scholarly journals, the search words applied included "paramedics" "emergency, medical services" and ambulance.The number of articles were noted and tabulated.In 2016, the total number of articles published in the four countries was 5,254 representing an increase of about 99% within the 9 year period.

Findings
Table 2 represents the total number of articles published in paramedics and emergency medical services in 13 countries across the world from 2007 to 2016.In 2007, a total of 2130 articles in the discipline were published in the discipline, which increased to 4,620 in 2016.This represented an increase of 116% within a period of 10 years (2007)(2008)(2009)(2010)(2011)(2012)(2013)(2014)(2015)(2016).Table 3 demonstrates the trend in publication of scholarly journals related to paramedics in 13 countries, from 1997-2016.The table demonstrates a gradual but slow increase in the number of journals published within the period, as indicated in figure 1 and figure 2.
Although there is has been a gradual increase in the number of scholarly research articles in paramedics and EMS published from 1997 to 2016 as indicated in figure 1 and figure 2, it does not compare with other disciplines in healthcare, such as nursing and medicine.

Discussions and Conclusion
To make research more pleasurable so as to foster life-long professional education and development, it should not be a process causing anxiety and pressure by spending more time reviewing various publications within the EMS framework.As researchers, we want to get our research to do it in a way that people will find accessible, enjoyable and engaging.I think it is time for all of us to begin looking at this continuing education system differently.For one, most if not all paramedics have to do, so obviously there is some benefit if the EMS field as a whole does this.From time to time, it is not uncommon to hear that EMS providers discuss about not being considered as part of the medical profession (not doctor or nurse) or being left out for this reason or that.May be making this change will be the first step in achieving a more level playing field with some of our counterparts.

Declaration of conflict of interest
All authors declared no potential conflicts of interest with respect to the research, authorship and publication of this article.
. Such research is use-inspired, if executed as part of a systematic and strategic program of inquiry, it can support new understandings at the most fundamental and basic scientific level, this applied to paramedic as well.EMS related research encompasses out-of-hospital based emergency cases, in the recent years; there has been a growing contribution to the literature byISSN 2250-3153 http://dx.doi.org/10.29322/IJSRP.8.12.2018.p8464www.ijsrp.org

Table 1 :
Countries with the highest Number of Research studies published in Paramedics and Emergency medical services from 2008-2016

Table 2 :
The total number of published Scholarly research studies in Paramedics and EMS in 13 countries, from 2007 -2016.
Figure 1: Published scholarly journals on Paramedics from 1997-2016 Figure 2: Number of scholarly research articles on Paramedics Published in 13 countries, from 2007-2016 http://dx.doi.org/10.29322/IJSRP.8.12.2018.p8464www.ijsrp.orgTable3: Journals published from 1997-2016 related to Paramedics Table 1 demonstrates the leading countries in the publication of research on paramedics and emergency medical services from 2008 to 2016.During the period, there has been a gradual increase and interest in the area of paramedic research, as indicated by the increasing number of the publications.In 2008, a total of 2, 638 research articles were published in four countries leading in paramedic research in the world, namely United States, United Kingdom, Australia and Canada.
Continuous professional development of paramedics should be made a mandatory component of medical practice to promote enhancement of skills, competence in addition to development and dissemination of new knowledge in EMS.However, this would require considerable investment by all stakeholders involved in EMS, including individual paramedic practitioners in taking stewardship of own learning.Addressing these issues is critical to promote a culture of lifelong learning and research in EMS practice.This would encourage a formation of a vibrant practice, which is updated on current best practices to promote professional and personal development.