Emergency Medicine Research Associates
Background
Unrecognized abdominal and pelvic injuries can result in catastrophic disability and death. Sporadic reports of “occult” injuries have generated concern, and physicians, fearing that they may miss such an injury, have adopted the practice of obtaining computed tomography on virtually all patients with significant blunt trauma. This practice exposes large numbers patients to dangerous radiation at considerable expense, while detecting injuries in a small minority of cases. Existing data suggest that a limited number of criteria can reliably identify blunt injury victims who have “no risk” of abdominal or pelvic injuries, and hence no need for computed tomography (CT), without misidentifying any injured patient. It is estimated that nationwide implementation of such criteria could result in an annual reduction in radiographic charges of $75 million, and a significant decrease in radiation exposure and radiation induced malignancies.
Objective
This study seeks to determine whether “low risk” criteria can reliably identify patients who have sustained significant abdominal or pelvic injuries and safely decrease CT imaging of blunt trauma patients.
Our Role
All blunt trauma victims undergoing computed tomography (CT) of the abdomen/pelvis in the emergency department (ED) will undergo routine clinical evaluations prior to radiographic imaging. Our volunteers will observe and record vitals for each trauma patient. We are also responsible for assuring that ED physicians record the presence or absence of specific clinical findings as well as the presence or absence of abdominal or pelvic injuries.
Background
The Mpox outbreak of 2022 has implications for people in the U.S. and across the globe. EDs act as the front line of defense for emerging infectious diseases, and Mpox is no exception; early evidence suggests that 20% of all cases are diagnosed in EDs. However, routine surveillance for emerging infectious diseases is rarely conducted in EDs. The mandate to use surveillance in EDs to identify public health threats and protect our communities is more apparent than ever before, since emerging infectious diseases disproportionately affect vulnerable patients such as persons with HIV (PWH) and historically under-represented groups. Furthermore, the risk factors for Mpox infection are not well-delineated, especially since this extra-African outbreak has different features than what has historically been described.
Objective
This study will serve as a surveillance project to test as many patients as possible who have rashes that could be due to Mpox infection based on rash appearance alone. The primary objectives of this project are to determine the prevalence of Mpox in the ED population, describe presenting symptoms and signs, characterize community risk factors for infection, and describe patients’ health outcomes.
Our Role
EMRAs will screen skin lesions and STIs on ED trackboard to identify potential CRASHED patients. For patients meeting all inclusion criteria that can be screened for, EMRAs will notify the SRAs and PIs and approach the resident and patient to obtain consent. EMRAs will communicate with the PIs, residents, and the SRA to ensure patient eligibility, complete documentation, and conduct telephone follow up surveys with patients and to document any changes.
Background
Suicide is currently the second leading cause of death for US youth ages 15-24, but evidence is limited regarding optimal interventions in the ED for reducing their risk of future suicide attempts. Current evidence supports some tested interventions for reducing later suicide attempts and encouraging further mental health treatment, but it is not yet known whether it is sufficient to provide only an evidence-based intervention in the ED, or whether additional therapeutic follow-up contacts are needed to improve youth outcomes.
Treatments
The study addresses this knowledge gap by comparing two evidence-based interventions for reducing suicide attempts and improving outcomes for youth presenting to EDs with suicidal episodes: (a) Safety-Acute(A), a crisis therapy session in the ED focused on enhancing safety (previously called Family Intervention for Suicide Prevention, FISP); and (b) SAFETY-A + Coping Long-term with Active Suicide Program (CLASP), comprised of brief therapeutic follow-up contacts after discharge from the ED/hospital.
Objective
The first aim is to evaluate whether SAFETY-A combined with CLASP aftercare is superior to SAFETY-A alone (with usual site referral and aftercare) for reducing the risk of suicide attempts and increasing initiation of follow-up mental health treatment. Second, the team will examine differences in how well the two study intervention approaches work for different groups of youth, especially those who are racial or ethnic minorities, from rural communities, or socioeconomically disadvantaged. Third, the team aims to increase the value and relevance of the study by engaging patients, parents, family members, providers, and system stakeholders involved in health and mental health care in project leadership and activities throughout the study.
Our Role
We screen the ED trackboard to identify adolescents presenting to the ED with suicidal ideation or behavior all days of the week at all times. If the patient meets inclusion criteria, we coordinate with both ED residents and the psychiatry department to help enroll the candidate.
Background
Novel psychoactive substances (NPS) are specifically designed to mimic the actions of known abused drugs, and currently pose a major public health threat. Novel synthetic fentanyl analogues (fentalogs) tend to have euphoric and sedative properties, greater potency, and higher addictive potential than morphine. The scope, incidence, prevalence and even the culprit molecules of fentalog overdoses are not known. Reports of the clinical effects of fentalogs have been unreliable as most studies utilize only self-report without toxicological testing. There is also currently no standardized approach to the diagnosis or management of fentalog OD for the majority of EDs. We also lack an understanding of the social determinants of overdose deaths compared to nonfatal overdoses, as well as an understanding on the evolving polysubstance use epidemic and its role in drug overdoses.
Objective
This study aims to molecularly identify and quantitate fentanyl analogues. Additionally, we will characterize psychostimulant drug co-ingestion with fentalogs (e.g. synthetic cannabinoids, cocaine, cathinones, etc.) to provide confirmatory identification and quantitation. This study will also evaluate the medical consequences (sequelae, clinical management, and resource utilization) of fentalog OD, as well as trend and geolocate confirmed fentalog OD and novel fentalog outbreaks. The related DOTS project will assess the sociodemographic characteristics, clinical information, and contextual data on opioid, stimulant, and/or undifferentiated illicit substance overdoses among patients presenting to participating hospitals around the United States to identify information about current overdose and to inform potential regulatory activities and future public health messaging.
Our Role
EMRAs will screen for potential patients in the Santa Monica and Ronald Reagan EDs by running an audit twice a day, screening for patients on CareConnect Trackboard at the beginning of every shift, and checking for the availability of discarded blood samples from the UCLA lab for a qualified patient.
Background
More than 380,000 patients suffer an out of hospital cardiac arrest (OHCA) each year in the US. Significantly improved outcomes in cardiac arrest are associated with early and aggressive resuscitation and treatment for these patients. Currently, early cardiac resuscitation is limited by the ability of physicians to protect the brain from global cerebral ischemia during resuscitation. Two recent trials have shown that early therapeutic cooling in comatose OHCA patients that present with shockable heart rhythms increases good neurological outcomes. These results have not been shown for patients with asystole or pulseless electrical activity (PEA). Duration of cooling and its effect on outcomes have also not been assessed.
Objective
There are two primary objectives relating to characterization of the duration-response curve for hypothermia in OHCA patients. The first is to determine the shortest duration of cooling that will provide maximal treatment effect. The second is to determine if cooling is more effective than non-cooling. There are three secondary objectives. The first is to characterize the safety of the various durations of cooling used. The second is to characterize the neuropsychological outcomes resulting from cooling and non-cooling in OHCA patients. The third is to characterize the effect of cooling on patient-reported quality of life.
Our Role
EMRAs will identify potential post-cardiac arrest comatose patients. EMRAs will subsequently head down to the ED where EMRAs will be in charge of gathering the paperwork and information needed to verify a patient is eligible. In the ED, EMRAs will also remind staff to initiate cooling and confirm that the care team has spoken with the family. Once EMRA confirms this and eligibility is confirmed, a Shepherd (resident working as a co-investigator for the trial) will be activated to obtain informed consent.
