Developing research in emergency care

There has historically been little research in Emergency Care, however recent initiatives through the National Institute of Heath Research (NIHR) have increased academic activity in this area. A number of academic centres are leading large RCTs, which will improve the evidence base in this area, however only a very small number of emergency care patients are entered into a clinical trial.
The delivery of emergency care research is assisted by the NIHR Injuries and Emergencies Specialist Group thought the Comprehensive Local Research Networks. These groups work within Regions to facilitate research and overcome barriers to delivery of projects. Within each NHS Region the College of Emergency Medicine has a research lead and there is a research lead within the ambulance service.
The Emergency Care environment presents a challenge to the researcher. The urgency of the clinical need makes it difficult for staff to spend time on trial entry, there are difficulties in gaining informed consent, and patients suitable for a trial arrive at unpredictable times throughout the day or night.
The conflict between the urgency of emergency care and the time needed for research clearly creates a difficulty. Successful research projects need additional resources so that research staff can undertake the trial while clinical staff continue with their work.
There is now a framework for consent in emergency care research provided by the Mental Capacity Act and the Medicines Regulations(1). There is a hierarchy of consent, which preserves the maximum of patient autonomy, but also allows necessary research to take place in incapacitated patients.