Brent Myers, MD MPH serves as the Chief Medical Officer ESO and brings over 30 years of experience in the EMS, Emergency Medicine, and Clinical Informatics spaces. He has served as an Emergency Department Technician in a rural hospital, a 9-1-1 response EMT, and completed his Residency in Emergency Medicine and an EMS Fellowship within the UNC School of Medicine System. He is the past-President of the North Carolina College of Emergency Physicians and the National Association of EMS Physicians (NAEMSP), served as the Director and Medical Director for the Wake County EMS System in Raleigh, and as Chief Medical Officer for Evolution Health/Associate Chief Medical Officer for AMR. He serves as an Editor for the NAEMSP Textbook for EMS Physicians and on the Editorial Board for Prehospital Emergency Care.
Q: You began research when you were the Medical Director of Raleigh Wake EMS in North Carolina (USA). Give us a brief overview of your research background and some of the challenges you’ve encountered, including how you overcame them.
A: Actually, my first research began as a medical student at Wake Forest University School of Medicine, using an animal model to demonstrate that magnesium was as efficacious as sodium bicarbonate for the treatment of dysrhythmias from tricyclic overdose. During my EMS Fellowship, I published on the compliance with location reporting to the local emergency management office for public-access Automated External defibrillators. For both of these projects, I relied heavily on my mentors to help me complete the projects. As part of my EMS Fellowship, I completed a master’s in public health, giving me the formal underpinnings of statistics and methodology for future research projects. In all of these circumstances, the difficulties revolved around time management – research was always the “side hustle” compared to the other tasks. Making this a personal priority was a key to success, as was the willingness to be vulnerable and ask for help/admit when I had reached the limits of my current knowledge.
Q: The poster you presented at the 2024 IAED NAVIGATOR conference was chosen out of 10 submissions to receive the Best Poster Award. Your research study compared Protocol 6: Breathing Problems and Protocol 26: Sick Person (Specific Diagnosis), starting with a call to 911 for help and finishing with EMS and hospital outcomes. What was the big takeaway from the research and why is it important for Emergency Dispatchers to be aware of your findings?
A: If I may, there were two significant findings: First, in a very large dataset, Protocols 6 and 26 accounted for ~ 20% of all 9-1-1 requests for EMS, so these are important protocols to understand from a population health perspective. Second, these protocols (and associated determinant codes) do a great job with respect to assigning patient acuity. We were able to link these protocols and determinant codes not just to EMS findings, but also to hospital outcomes. This confirmed that 26-ALPHA patients are very unlikely to experience a time-critical illness while 6-DELTA patients have a substantial risk of time-critical illness.
Q: You’ve been involved with more than 50 published studies. Tell us about a few of the most important findings from your research and explain their significance.
A: First, I want to thank of the collaborators I have had the good fortune to work with over the years – research is absolutely a team sport. Second, a few key findings: Recently, we were able to take a large, integrated dataset and evaluate the outcomes for patients who receive out-of-hospital ketamine. After rigorous review (inclusive of hospital outcomes), we were able to determine that ketamine was very safe when given appropriately, inclusive of the recommended monitoring. In addition to the dispatch study presented at Navigator, we recently published the largest dispatch-to-discharge study ever completed – with over 500,000 cases from 8 systems with IAED Accredited Centers. This demonstrated an overall excellent performance of the MPDS system with respect to the assignment of patient acuity while also calling attention to the increased risk associated with any patient experiencing an allergic reaction. https://www.tandfonline.com/eprint/QAPVFVFGJRPVDGWD3JKX/full?target=10.1080/10903127.2024.2342015
Q: A lot of EMS researchers skip over the topic of emergency medical dispatch—you haven’t. Can you tell us why the Emergency Medical Dispatcher is an important part of the EMS patient encounter? What topics should future EMS/Dispatch studies focus on for maximum benefit to the system and our patients?
A: The simple answer is this: The EMD is the “front door” to the EMS system and as such allows for optimum resource utilization and response. There are many examples of why this is vital; let’s just look at two. First, nearly every EMS system today experiences times when there are more requests for service than there are resources to dispatch. In the absence of EMD, by necessity resources are dispatched on a “first come, first serve” basis, meaning a Cardiac Arrest could have a lethal delayed response because the nearest resource was recently dispatched for a Sick Person. The EMD provides an evidence-based method to rationally assign resources. Second, responding with lights and sirens is dangerous; again, EMD provides evidence-based support to decrease light-and-sirens responses when clinically appropriate.
Future studies should focus on the outcome of the patient, not how fast EMS responded. In addition to the mode of response, we should study which requests can have a delayed dispatch to preserve resources or which requests may not need a dispatched resource at all. This latter group may be eligible for nurse advice or telemedicine – we just need the patient-centered evidence to guide us.
Q: You believe in the power of mentorship. In what areas have mentors helped you get where you are now? What advice would you give to someone who is looking for a mentor—especially in the research realm?
A: The most important thing about being a mentor is to meet your mentee “where they are” with patience and without judgment. Mentees will only be successful if they are doing work that is interesting to them in an environment where they are not afraid to fail or admit the limits of their knowledge. Setting them up to succeed is key, so make sure you have the bandwidth to offer – it will take you much longer to complete the project with a mentee than it would do it on your own. That said, there is no better way to spend your time!
Q: Outside of research and other work duties, what do you like to do in your free time?
A: My husband and I love to travel, particularly to NYC to take in Broadway shows or to Chicago, but really any travel is great with us. We also love to boat, cook, and entertain. Finally, we love taking our family to a new Major League Ballpark each summer – we just returned from seeing a Nationals game in DC.