Emergency Prehospital Investigative Consortium (EPIC)

描述（由申请人提供）： 鉴于与损伤和心源性猝死相关的广泛发病率和死亡率，有必要对创新疗法进行评估。 通过在院外环境中早期应用治疗来降低死亡率和改善功能结局是有希望的。 从危及生命的损伤和心脏性猝死中复苏的时间依赖性要求在这两种疾病状态下评估潜在的干预措施，包括紧急医疗服务（EMS）系统。成功的院前复苏干预措施的科学研究需要一个成熟的EMS系统，该系统具有以下特征：与最先进的医院护理有效整合;在院外人员和医院调查人员之间建立合作关系;以及从院外环境开始到出院后纵向结局结束的全面前瞻性数据收集。 该提案总结了多学科紧急院前调查联盟（EPIC）团队的广泛EMS研究经验，并详细说明了EPIC团队所属的社区和EMS机构如何满足这一理想EMS调查环境的目标。 这项建议的具体目标如下： - 在波特兰大都会区和周边地区利用EMS和医院研究基础设施，对严重创伤和心脏骤停的受害者进行先进的介入复苏研究，作为EPIC试验的一部分; - 进行一项随机对照试验，研究高渗盐水在中度至重度创伤性脑损伤中的疗效;以及 - 进行一项随机对照试验，研究在院外心肺骤停中使用血管加压素与肾上腺素的比较。 - 描述一个研究技能培训核心，将促进临床研究人员的发展，他们将解决未来的EMS和创伤/心脏复苏问题。

DESCRIPTION (provided by applicant): Given the extensive morbidity and mortality associated with injury and sudden cardiac death, evaluation of innovative therapies is warranted. The reduction of mortality and improvement of functional outcomes through early application of therapies in the out-of-hospital setting is promising. The time-dependent nature of resuscitation from both life-threatening injury and sudden cardiac death requires that evaluation of potential interventions in both of these disease states incorporate the Emergency Medical Services (EMS) system. Successful scientific investigation of proposed prehospital resuscitation interventions mandates a mature EMS system with the following features: effective integration with state-of-the-art hospital care; established collaborative relationships between out-of-hospital personnel and hospital-based investigators; and comprehensive, prospective data collection beginning in the out-of-hospital setting and ending with postdischarge longitudinal outcomes. This proposal summarizes the extensive EMS research experience of the multidisciplinary Emergency Prehospital Investigative Consortium (EPIC) team and details how the community and EMS agencies affiliated with the EPIC team meets the goals of this ideal EMS investigative environment. The specific aims of this proposal are as follows: -To use the EMS and hospital-based research infrastructure in the Portland Metropolitan Area and surrounding region to carry out advanced interventional resuscitation research on victims of major trauma and of cardiac arrest as part of the EPIC trial; -To conduct a randomized, controlled trial studying the efficacy of hypertonic saline in moderate to severe traumatic brain injury; and - To conduct a randomized, controlled trial studying the use of vasopressin versus epinephrine in out of-hospital cardiopulmonary arrest. - To describe a Research Skills Training Core that will foster the development of clinical researchers who will address future EMS and trauma/cardiac resuscitation concerns.