The U942 entitled MASCOT coordinates projects on new ways of dealing with patients in critical situations.
To this end, the Unit explores very precise phenotyping of patients, understanding of critical pathologies and coordinates big data analysis efforts with the aim of identifying new treatments, including biotherapies.
Clinical research is a demanding discipline in which complex, multi-centre, high-quality studies are often carried out in a context of international competition and ever-changing regulations.
The Unité de Recherches Cliniques de l’Est Parisien (URC-Est) provides assistance and expertise to doctors and paramedics at all stages of their research: preparing the protocol, obtaining calls for tender and funding, setting up and coordinating clinical studies, data management, analysis and publication of results.
Its experience in national and international clinical trials, including in emergency departments, is an asset to assist IMPEC members in their research work.
1. Acute management of critically ill patients – Pr. Frédéric Adnet
This research area focuses on the early management of patients in critical situations, i.e. life-threatening emergencies. Through research and our work, the objective is to improve the prognosis of these patients taken care of in the initial phase in the pre-hospital phase or in the emergency services. This workpackage is divided into 3 main themes:
– Cardiac arrest
Cardiac arrest is a major cause of mortality. The rapid identification of the situation and the application of well-coded resuscitation manoeuvres represent the essential challenges in the management of this pathology. In this area, our research projects focus mainly on the detection, management and optimisation of early care, in particular on the evaluation of the relevance and effectiveness of the drugs to be administered and the optimal timing for initiating resuscitation or airway protection procedures.
Sepsis is responsible for significant morbidity and mortality and its management is a priority for the World Health Organisation. The majority of sepsis cases originate in emergency departments. One of the problems is the definition and early detection of the pathology to optimise management. Our research focuses on the early identification of sepsis and its severity, in particular by combining clinical and biomarkers. Our work also includes the evaluation of care procedures and the assessment of recommendations and their applicability.
– Major trauma
Our research focuses on optimising the early management of major trauma patients. In this area, studies are underway or planned to improve the pre-hospital management of these patients by testing the risks and benefits of hyperoxia or hypothermia.
In these different pathologies as well as in all those engaging the vital prognosis in the short term, the objective of our research work is to secure and optimise the management of these patients, by an improvement of the diagnostic approach and an evaluation of the therapeutic performance.
2. Health care access for vulnerable people – Dr Anne-Laure Féral-Pierssens
The work of this research theme is based on two different angles of approach. The first deals with access to care for specific populations, while the second focuses on the health system. It is thus a question of:
– The analysis targets specific populations that present one or more factors of vulnerability. Vulnerability is defined here as a situation of fragility that can affect different areas or spaces (biological, physical, economic, social, cultural). The aim is to study the care pathway, the methods of recourse and the characteristics of emergency care for a particular population (elderly patients with a loss of autonomy, foreigners without social support, women who are victims of violence, prison populations, obese people, allophone patients, frequent users of emergency services, etc.).
– The study of the interactions between the organisation of the supply of care upstream and downstream of emergency services and the pathways of vulnerable populations. The characteristics of the health system influence the care pathways and accessibility of vulnerable populations. This study describes the impact of these characteristics on the use of emergency care: the introduction or modification of social protection systems, the development of specific and targeted public health policies, the territorial organisation of health care provision, the articulation of public/private or outpatient/hospital provision.
While some of these studies are descriptive and observational, others tend to analyse the impact of specific interventions or policies on access to care, recourse and emergency care for vulnerable populations. The analysis of training and awareness-raising policies for emergency professionals on these issues is also part of this theme.
Thus, the work carried out in this context is built at the intersection of several fields of research. It is conducive to interdisciplinary collaboration between emergency medicine, public health, economics, political science and sociology, and makes it possible to mobilise complementary quantitative and qualitative methodologies.
3. Nursing Science – Judith Leblanc
This work package aims to encourage the development of research projects led by paramedical professionals, as it is essential to better evaluate care practices in emergency departments and to develop innovative strategies. It is based on raising professionals’ awareness of the research process by disseminating the completion of current research projects, encouraging the emergence of project ideas and supporting their completion, while encouraging university training (master’s degree, doctorate) or short courses for paramedical professionals. This workpackage brings together resource persons in the field who have expertise and/or an interest in research.
The research work carried out, in progress and to come, concerns various themes and is interventional or observational. They are essentially carried out or initiated by paramedical professionals but rely on the participation of multidisciplinary teams. As an example, we can mention some projects or themes.
– A project on the impact of a protocol for screening for tobacco consumption and initiating smoking cessation during an emergency room consultation was submitted to and selected in a call for research projects by the INCa to combat the use of and addiction to psychoactive substances.
– In the context of HIV infection, emergency departments have played an important role in recent years in the evaluation of national recommendations. The DICI-HIV trial conducted in 2014-2015 in 8 emergency departments in the Ile-de-France region explored a nursing HIV screening approach targeting key populations. French health authorities have since recommended targeted screening in non-specialist care settings. The DEPIST-VIH trial, currently suspended, will evaluate the effectiveness and feasibility of the strategy on a large scale in 18 emergency departments in the region. The results will help to better adapt HIV testing strategies in these departments and to define the nursing contribution.
– The DEPIST-COVID trial financed by the ANRS | Emerging Infectious Diseases and the Ile-de-France Region is underway. The identification of people carrying the SARS-CoV2 virus and their very early isolation is made difficult by the large proportion of asymptomatic or pauci symptomatic people who transmit the virus without knowing it. The appropriate strategy to identify these forms that escape diagnosis based on the detection of symptoms remains to be determined. The aim of the study is to evaluate the interest of a systematic proposal of screening for SARS-CoV2 in 18 emergency departments in Ile-de-France. Emergency departments are a place frequented by all segments of the population, including people with fewer resources. The interest of the study is to intensify the proposal of screening among populations that may be more exposed to the risk of SARS-CoV2 infection and are not included in other screening mechanisms. This work should help optimise strategies to identify pauci or asymptomatic carriers and thus contribute to better control of the epidemic.
– Analysis of the AP-HP Health Data Warehouse data from a nursing or paramedical perspective can be used to study nursing practices and develop research in emergency departments. Paramedical professionals are being trained in the use of EDS data. It is a new research tool to be developed.
– Finally, the recent training of advanced practice nurses in France and the creation of an “Emergency” mention from September 2021 favour the emergence of new missions and the evaluation of their organisation and impact in emergency services. Research projects can be envisaged with this perspective (in connection with WP3 & WP2).
4. Medical education, error management and human factors – Dr Anne-Laure Philippon
Three research axes are developed within this workpackage, which aims to analyse work situations in emergency medicine, with a focus on the human and systematic factors that contribute to the improvement of medical practice in emergency situations. The issues of training of health professionals are also at the heart of the research work, and particularly the contribution of simulation in the training course.
The first line of work concerns the contribution of evaluation by simulation in emergency medicine. Several research questions are currently being addressed and concern the way in which an evaluation score for a simulated situation can be developed, but also the evaluation of students with simulation in situ, and therefore in the field. The work is situated within the framework of the competency-based approach.
The second line of work focuses on the analysis of in situ simulation: feasibility of implementation, contribution to work analysis and impact on the management of emergency patients.
The third part of the project will focus on the analysis of the activity within emergency medicine services and raises the question of the sources of error in emergency medicine, based on the observation of work and with a view to the analysis of human factors and within the framework of crisis management, otherwise known as “crisis resource management”.
Finally, a last line of research concerns the possibility of carrying out prevention actions in emergency rooms, using brief intervention methods, within the framework of an approach that is both multidisciplinary (emergency medicine and addictology) and interprofessional (medical and paramedical research). This last line of research is linked to WP 3.
5. Experience of Emergency : stress and consequences among patients and caregivers – Dr Jennifer Truchot
Projects in progress
Home-based remote medical monitoring of patients with or suspected of having COVID-19
Dr Youri Yordanov (PHRC, Fondation de France 2020)
Non-invasive airway management of comatose poisoned emergency patients
Pr Yonathan Freund (PHRC-N, 2019)