Global Research Review: Issue 5

Published on July 11, 2013
The Best Global Emergency Medicine Research

In recent years, the growth of emergency medicine around the globe has been exponential, with nearly 70 countries now granting some form of formal recognition to the field. At the same time, interest in Global Emergency Medicine (GEM) as a unique subspecialty of emergency medicine has also grown rapidly over the past decade. International sections, interest groups, and committees now exist within many emergency medicine organizations across North America and Europe, and in some cases have become the largest special interest sections within these organizations. One of the barriers, however, to the development of the nascent field of GEM has been the lack of an easily accessible literature base that can be used to guide its development. Both research articles and communiqués of value to various stakeholders in GEM are spread throughout the general medical literature, the emergency medicine literature, the public health literature, the health policy/health systems literature, and the humanitarian/disaster literature. Many publications with GEM relevance exist only in the gray literature in the form of assessments or reports by international agencies, national or local governments, foundations, donor agencies, financial institutions, or non-governmental organizations. Furthermore, GEM research may be published in a variety of different languages, further limiting its accessibility to a global audience of emergency medicine practitioners.

Recognizing the need for a clear and accessible literature base to guide the growing field of GEM, the International Emergency Medicine Literature Review Group was formed in 2005. Publishing annually in the journal Academic Emergency Medicine, this review gathers together a number of articles from disparate sources, presenting the ones chosen as having specific relevance or value to the field of global emergency medicine. The goals of the review are to illustrate best practices, stimulate additional research, and promote further professionalization of the field of global emergency medicine.

Before we can review the global emergency medicine literature, however, we must first define the boundaries of the field. For the purpose of our review, we have created a framework that divides GEM research into one of three categories: development of emergency medical care systems in both developed and developing nations, delivery of emergency care in resource limited settings, and provision of humanitarian and disaster relief. Emergency medicine development encompasses clinical, educational and systems components at both the national and local levels. Included within this rubric would be efforts as diverse as developing a national disaster relief plan, creating a city-wide EMS system, and training rural health practitioners to provide basic emergency services. Emergency care in resource limited settings deals with adapting old methods and developing new methods for providing acute medical care and trauma care in rural areas and low-income countries,where advanced technology and specialist physicians may not be available. The field of humanitarian relief also encompasses several different domains, and is rapidly becoming more organized through critical analyses of operations executed. Both humanitarian relief agencies and donor governments are looking closely at ways to improve humanitarian response, including the conduct of rapid needs assessments, the deployment of personnel and supplies, and ongoing monitoring and evaluation.

Each year, we perform a Medline search of the published literature using a set of structured terms that we have honed over time, as well as a search of the grey literature using a variety of databases and algorithms. Our multilingual team of reviewers then screens the thousands of citations captured by our search to find the few hundred studies that clearly fall within the realm of GEM, as defined above. Our reviewers then read and score each manuscript, using a set of questions that evaluates the clarity, methodology, ethics, importance, and likely impact of each study in order to find the top GEM articles published each year. Finally, our reviewers provide a summary and critique of each article, for the benefit of our readers.

In addition to reviewing the highest quality and most important research studies of the year, the review also identifies and tracks emerging trends in GEM research. Our 2008 review, for instance, noted an explosion of articles related to pandemic response, as well as articles detailing the importance of international collaboration in the development of emergency care systems around the globe. In our 2009 review, we found many more articles focusing on issues related to disaster response, including the evaluation of various triage systems, methods of rationing care in humanitarian emergencies, and the ethics of both humanitarians responding to disasters and conducting research to study the humanitarian response to disasters. Our 2010 review, in turn, found a shift towards articles falling within the realm of emergency care in resource limited settings, especially those related to maternal and child health. Indeed, we saw several excellent studies identifying better methods for diagnosing and treating acute respiratory infections, diarrhea, and malaria in children in the developing world, as well as a number of randomized controlled trials aimed at preventing complications of obstetric emergencies such as post-partum hemorrhage or preterm labor. The 2010 review also noted a number of new studies specifically analyzing trauma care in thedeveloping world, including road traffic accidents and domestic violence, looking at the systems-level barriers and solutions to improving care for patients with traumatic injuries. Overall, our annual reviews have also noted a consistent improvement over the past several years in the methodological quality of global emergency medicine research. Clearly, global emergency medicine research is finally coming into its own as a rigorous scientific field.

In this current issue of EPI, we highlight a few of the top research articles identified by our 2010 International Emergency Medicine Literature Review. In future issues of EPI, we will continue to provide additional snapshots of cutting edge global emergency medicine research from around the globe. For a more in-depth discussion of the methodology and results for our annual review, as well as for summaries and critiques of the top 27 GEM articles of 2010, please see our full review at www.aemj.org.

This article originally appeared in issue 5 of Emergency Physicians International

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