Clinical Paramedic Research Resource
Welcome to the homepage of current and upcoming studies occurring at emergency departments for clinicians, along with resources available for clinicians interested in research.
This initiative aims to collaborate with all health care providers and make research opportunities accessible to everyone.
We can help you develop a research question, apply for grants, assist with Research Ethics Approval, and support you in the research process. Please get in touch with the Research Manager.
Megi Nallbani
megi.nallbani@nshealth.ca
902-476-1471
Please check back, this information will be updated regularly.
Current Studies in the Emergency Department
RANDOMIZED CONTROLLED TRIALS
RAFF4 Trial: Vernakalant vs. Procainamide for Acute Atrial Fibrillation in the Emergency Department
A research study is being conducted in 12 EDs across Canada to assess IV vernakalant’s effectiveness, speed, and safety compared to IV procainamide for treating patients with acute atrial fibrillation in the ED. The study aims to determine which medication is better for patients. Although Health Canada approves both drugs, IV vernakalant is a newer medication yet to be widely used in EDs across Canada. The study will compare the two treatment options to determine which is more effective. Participants will be randomly assigned to one of two treatment groups and receive either IV procainamide or IV vernakalant. A follow-up call will be made to the participants after 30 days of their visit.
Eligibility: A conscious adult over 18 who is currently experiencing atrial fibrillation for over 3 hours and under seven days. The research assistant will be notified and continue to investigate further inclusion/exclusion criteria for the study.
Clinician Involvement: Anyone can notify the research assistants of potential patients eligible for the study.
The attending physician will consult with the RA , review the inclusion/exclusion criteria for the participants, and order the medications.
The attending nurse will retrieve and infuse the medications as per the study protocol.
Other opportunities for ECG and cardioversion if medication administration is unsuccessful.
Goals: We hope to enroll 340 in this study.
Principal Investigators: Samuel Campbell and Mary-Lynn Watson
| Site | Start Date | Enrolled |
| TOH: Civic | 14-Jun-2021 | 75 |
| TOH: General | 14-Jun-2021 | 32 |
| HSC | 4-Oct-2021 | 9 |
| MHI | 12-Oct-2021 | 21 |
| QHLI | 18-Oct-2021 | 31 |
| HEJ | 8-Nov-2021 | 20 |
| Kingston | 6-Dec-2021 | 17 |
| QEII | 13-Dec-2021 | 20 (+2 since August) |
| VGH | 3-Oct-2022 | 22 |
| Foothills | 25-Aug-2023 | 1 |
| Total | 248 |
REmote cardiac MOnitoring of at-risk SYNCope patients after Emergency Department discharge – A Multicenter Randomized Controlled Trial: (REMOSYNCED – RCT)
Individuals who experience a fainting episode may be invited to participate in a study. This study aims to determine if a 15-day outpatient cardiac monitoring approach can detect more patients with heart rhythm issues that require treatment compared to standard care. Additionally, we will examine if this monitoring approach can (1) exclude heart rhythm problems in patients who experience fainting or near-fainting episodes during the monitoring period, (2) identify non-heart rhythm-related conditions, and (3) achieve the same results with a shorter monitoring duration. An observational study in this research will utilize the collected data to enhance the understanding of syncope risk scores.
Clinician involvement: fill out the form; ED RA will collect the forms. If the participant’s score is under 3, the participant will receive a telephone follow-up; if it is above 3, the participant will be contacted by Cardiology RA to arrange cardiac monitoring. Dropbox in Research Hallway
Pod 2/3
Goal: Enroll 74 participants between Halifax Infirmary and Dartmouth General Hospital.
Principal Investigators: Matthew Clarke, Bobby Pomerleau, and Ravi Parkash
| Site | Observational | RCT | Excluded | Total Forms |
| TOH: Civic | 466 | 18 | 268 | 754 |
| TOH: General | 394 | 13 | 237 | 646 |
| Queensway Carleton | 572 | 11 | 162 | 745 |
| QEII | 39 (+10 since August) | 5 (missed) | 68 | 112 |
| DGH | N/A | 0 | 40 | 40 |
| Total | 1473 | 57 | 776 | 2325 |
DATABASE
Atlantic Canadian Emergency Medicine Airway Interventions Registry and Observational (AIRO) Database
The main goal of this study is to investigate the incidence and management of airway emergencies in various EDs across Atlantic Canada. The study will gather data from past records, direct observations, and self-reports on the measures taken during airway emergencies in EDs and their outcomes. The data will be recorded in a database and analyzed to identify relevant factors.
Clinician involvement: To complete and ensure the Post Intubation form is filled out and submitted to the Pod 1 Intubation box/AIRO REDCap Survey
Principal Investigators: Adam Parks and George Kovacs
REFERRAL TO STUDIES
Understanding Cannabis-related Physical and Mental Health Presentations to the Emergency Department Following the Legalization of Non-medical Cannabis Use
The study aims to investigate in-depth patients with adverse events about cannabis use requiring ED presentations, including determining associated risk factors and healthcare demands. This unique collaborative Emergency Medicine and Psychiatry study will be completed in Nova Scotia at the four adult EDs (Halifax, Dartmouth, Sackville and Sydney) and the IWK Children’s Hospital ED. For the individuals who consent, we will collect healthcare and interview/rating scale data in addition to the chart review data at the study entry and three months later. We will also retrospectively collect data on healthcare contacts 24 months before the emergency department visit for those enrolled in this part of the study. Participants will also be involved in a phone interview about cannabis use (including strain, method of use, and frequency)
Eligibility: Individuals presenting to the ED with a cannabis-related complaint from age 10+ will be offered enrollment in the study.
Clinician involvement: referral to the study, dropbox in Pod 1
Goal: 1500 participants
Principal Investigators: Kirk Magee, Jason Emsley
COMPLETED STUDIES
Canadian COVID-19 Emergency Department (ED) Rapid Response Network (CCEDRRN)
Since 2020, the registry has been analyzing various factors related to patients who come to the emergency department with symptoms of COVID-19. They collect data on patients who test positive or negative for COVID-19, including information on medications, vitals, and bloodwork. Additionally, this registry conducts telephone follow-ups with patients at 30 days, 3 months, 6 months, and 1 year after their initial ED visit to track post-COVID symptoms, experiences, and vaccination statuses.
Clinician involvement: none; there is no direct patient contact for this study
Goals: We would like to publish a few publications on the data analysis of the multiple factors collected.
Principal Investigators: Patrick Fok and Hana Wiemer
External Validation of a Prognostic Risk Score for Safe Discharge among Patients with Lower Gastrointestinal Bleeding: A Prospective Multi-Centre Cohort Study
The Division of Digestive Care and Endoscopy, in partnership with the Emergency Department at the NHI, has launched a prospective multi-center observational study to validate the Oakland-Jairath LGIB risk score. The study will span six months and involve patients with risk scores calculated and monitored for adverse outcomes over 28 days. The risk score will be used solely for research purposes but will be made available to treating physicians upon request, as the score’s details are publicly accessible.
Eligibility: Presenting complaint of LGIB, defined as bright red blood per rectum or maroon-coloured stool. Both apply regardless of if blood is seen without stool, with stool of any consistency, or only on toilet paper.
Clinician involvement: In the ED, participants with LGIB will be identified for study screening. The ask will be for the ED staff to identify potential participants’ information and place them in the dropbox placed in Pod 1 and 5.
Goals: We hope to enroll 30 in this study.
Enrolled: 32! 😊
Principal Investigators: Samuel Campbell and Hana Wiemer
Upcoming Studies in the Emergency Department
Diagnostic performance of ULD vs. LD CT protocols in detection of urolithiasis: A prospective intra-individual non-inferiority study
The study aims to determine if an ultra-low dose (ULD) CT scan can be as effective as a low-dose CT scan in detecting kidney stones. Participants will undergo a standard low-dose CT scan and a ULD CT scan. We will compare the results of both scans to assess if the low-dose CT scan is reliable enough for kidney stone diagnosis.
Clinician involvement: TBD; however, it will include involving the patient to consent to receive CT Study Protocol.
Proposed Start: mid-September/early October 2023
Principal Investigators: Simon Field and Samuel Campbell
Paramedics Providing POCUS for Difficult Intravenous Access in the Emergency Department
One of the roles of Advanced Care and Critical Care Paramedics at the Charles V. Keating Emergency Department and Trauma Centre in Halifax, Nova Scotia, is assisting with placing intravenous catheters in patients with difficult intravenous access (DIVA). There is no known research in Canada on emergency department paramedics providing point-of-care-ultrasound (POCUS) to patients, let alone difficult intravenous cannulation. The study will consist of a 3-month observation period before the 1-day training session, followed by a 9-month observation with the Butterly iQ+ ultrasound This research study is being done to address a knowledge gap and quality of care for patients. The study may show the value of including POCUS training as a standard for paramedics.
Clinician involvement: Alert ACP/CCPs about potential DIVA, ACP/CCPs enrolled in the study will collect data.
Proposed Start: November 2023
Principal Investigators: Ryan Fitzpatrick and Samuel Campbell
Resources for Paramedics
Grants and Bursaries offered by Dalhousie University
Research Performance Grant – supporting pre-hospital research
Two of these bursaries will be awarded annually to offset the direct costs of performing pre-hospital research. A performance bursary can be up to $5,000 and can be renewed once after the submission of a progress report to the Division of EMS.
Application deadlines: February 1 and September 1.
https://medicine.dal.ca/departments/department-sites/emergency/divisions/ems/education/bursaries/research-performance.html
Research Knowledge Translation Grant – supporting the sharing of knowledge
The Knowledge Translation Bursary is awarded to help with costs associated with presenting original research at research sessions and conferences. The applicant must be either the primary investigator or co-investigator and the presentation may be oral or via poster.
The bursary is worth up to $3,000. A maximum of $6,000 can be awarded annually (two bursaries of $3,000 each or three bursaries of $2,000 each).
Application deadline: There are two application deadlines per year (March 31 & September 30)
https://medicine.dal.ca/departments/department-sites/emergency/divisions/ems/education/bursaries/knowledge-translation.html
Research Postgraduate Bursary – supporting paramedic training
This bursary is awarded annually to a paramedic wishing to enroll in a master’s or PhD program at a recognized institution. An amount of up to $3,000 per year, for a maximum of two years, is available to help cover tuition costs
Clinical Cadaver Research Program Grant
This grant is available for projects that use clinical cadavers as a source of research with the ultimate goal of improving patient outcomes. This includes research projects in undergraduate, postgraduate and continuing medical education in which clinical cadavers are used. In addition, projects that impact a broad group of learners and contribute to our understanding of how cadavers are best used as a simulation resource will be given preference.
Funding Available from NSHA
Nova Scotia Health’s Research Fund is an internal funding program at Nova Scotia Health that aims to build the capacity of Nova Scotia Health researchers and helps to catalyze new research opportunities.
- Category 1 – up to $100,000 over 3 years. For experienced researchers who are based at or affiliated with Nova Scotia Health
- Category 2 – up to $100,000 over 3 years. For early career researchers who are based at or affiliated with Nova Scotia Health
- Category 3 – up to $50,000 over 2 years. For researchers based at or affiliated with affiliated with Nova Scotia Health
- Category 4 – up to $10,000 over 1 year. For research students and trainees based at or affiliated with Nova Scotia Health
Categories 1-3 are open to all Nova Scotia Health team members – including physicians, nursing and allied health professionals, administrators, other employees, and Scientific Affiliates.
Category 4 is open to students and trainees at post-secondary institutions in Nova Scotia who are either already affiliated with Nova Scotia Health (e.g. as medical residents or other student learners) or who are willing to become Nova Scotia Health employees for their proposed project and who also have a supervisor who is affiliated with Nova Scotia Health as a physician, employee, or Affiliate Scientist.
Priority will be given to research grants that align with the priorities of Nova Scotia Health, the Department of Health and Wellness, and the Department of Seniors and Long-Term Care, including:
- Aging and continuing care
- Mental health and addictions
- Vulnerable populations
- Expanding telehealth/virtual care
- Chronic illness
- Improving access to primary health providers
- Recruitment and retention of health professionals
- Addressing surgical wait times
- Women’s Health
- Prescription drug coverage
- Overall patient access and flow
QEII Foundation Translating Research Into Care (TRIC)
The research program was established in 2013 with funding from the QEII Foundation. The funding program supports research that will provide evidence and facilitate the translation of clinical science into improved healthcare policy, service delivery and patient care at the QEII Health Sciences Centre, and across NSHA.
Three levels of funding support are available:
- Level 1: up to $3,000 over one year
- Level 2: up to $30,000 over one or two years
- Level 3: up to $60,000 over two years
QEII Foundation TRIC Grants Must:
- Lead to improved health care at the QEII or NSHA
- Be co-led by a researcher and an administrator
- Include the patient voice
- Be able to be implemented and sustained at the health centre(s) where the research takes place
- Funding from the QEII Foundation TRIC program will cover research costs; however, all operational costs must be absorbed by the department/unit involved and signed off by the Administrative Co-PI.
Priority will be given to QEII Foundation TRIC grant applications that do one or more of the following:
- Improve patient-reported outcomes
- Improve the safety of healthcare
- Improve wait times for healthcare
- Reduce the need for healthcare
- Improve access for under-served populations
- Identify and reduce unnecessary healthcare costs.
- Reduce unnecessary interventions and de-adopt unnecessary tests, interventions or clinical practices that are of low value.
In addition, there are bursaries and grants through other funding agencies; please contact the Research Manager.
In addition, there are bursaries and grants through other funding agencies; please contact the Research Manager.
Research Courses and Opportunities
Paramedic-Evidence Based Practice Couse (P-EBP)
Offered in-person and online, this course was developed to give paramedics the tools to search for answers to their clinical questions. The P-EBP focuses on developing a concise PICO question, creating a search strategy in PubMed, and critically appraising the literature they uncover. In addition, the course introduces concepts of research study design, ethics, validity, and level of evidence and briefly touches on bio-stats.
Cost: $40-60
https://emspep.cdha.nshealth.ca/Default.aspx
Prehospital Evidence-Based Practice Program
The PEP program primarily aims to share information with the EMS community. Appraisers volunteer their time and efforts to contribute to the Program. Appraisers will read one article each month and rank the evidence and intervention
The purposes of the Prehospital Evidence-Based Practice Program are.
- to catalogue EMS studies
- to stimulate debate and growth towards evidence-based clinical presentations
- to be a resource for developing local EMS clinical presentations, perhaps with a movement towards “best practice” paramedic clinical presentations.
- to be a guide to help recognize opportunities for pre-hospital research.
- to develop a process of using evidence to evaluate practice change suggestions made by paramedics.
https://emspep.cdha.nshealth.ca/Default.aspx
Publications Lead by Paramedics
Jensen J, Travers A, Carter A. Care begins when 9-1-1 is called: the evolving role of paramedic specialists in EMS Medical Communications Centres. CJEM 2022; 24(2):115=6
Carrigan S, Goldstein J, Carter A, Asada Y, Travers A. The prevalence and characteristics of non-transports in a provincial emergency medical services program: A population-based study. J Emer Med 2022; 1-11
Hurtubise M, Stirling J, Greene J, Carter A, Swain J, Brown R, Fidgen D, Goldstein J. Dextrose 50% versus Dextrose 10% or Dextrose Titration for the Treatment of Out-of-Hospital Hypoglycemia: A Systematic Review. Prehosp Dis Med 2021; 36(6):730-8