title: Conducting research using the emergency exception from informed consent: the Public Access Defibrillation (PAD) Trial experience.
abstract: BACKGROUND
  The Public Access Defibrillation (PAD) Trial, a prospective, multicenter, randomized clinical trial comparing two prehospital resuscitation strategies, was conducted under the regulations for exception from informed consent (21CFR50.24) in 24 communities in North America. These regulations place additional requirements for human subject protection on investigators and Institutional Review Boards (IRBs), including conducting community consultation (CC) and public disclosure (PD).
  
  
  OBJECTIVE
  To describe the IRB approval process at study sites and the number and types of community consultation and public disclosure activities conducted.
  
  
  METHODS
  The 24 study sites in the United States and Canada submitted IRB applications, CC and PD plans, and a structured report on IRB process and investigator perceptions to the Clinical Trial Center at the University of Washington.
  
  
  RESULTS
  The primary IRBs for all 24 trial sites and a total of 101 IRBs approved the study. The median interval from submission to approval was 108 days (IQR 43-196), and the mean number of revisions was two (range 0-7). Investigators conducted nearly 12,000 activities to achieve CC and PD; activities varied greatly from site to site in both type and quantity.
  
  
  CONCLUSIONS
  The length of time to obtain IRB approval and the extent of community consultation and public disclosure varied greatly among trial sites in meeting the current regulations for conducting emergency research with exception from informed consent. This suggests that more specific guidance may be useful and that determination of effective strategies for community consultation and public disclosure is needed.
authors.affiliation: Department of Emergency Medicine, University of Pittsburgh School of Medicine, 230 McKee Place, Suite 400, Pittsburgh, PA 15213, USA. mosessovn@upmc.edu
authors.forename: Vincent N
authors.initials: VN
authors.lastname: Mosesso
authors.forename: Lawrence H
authors.initials: LH
authors.lastname: Brown
authors.forename: H Leon
authors.initials: HL
authors.lastname: Greene
authors.forename: Terri A
authors.initials: TA
authors.lastname: Schmidt
authors.forename: Tom P
authors.initials: TP
authors.lastname: Aufderheide
authors.forename: Michael R
authors.initials: MR
authors.lastname: Sayre
authors.forename: Shannon W
authors.initials: SW
authors.lastname: Stephens
authors.forename: Andrew
authors.initials: A
authors.lastname: Travers
authors.forename: Richard A
authors.initials: RA
authors.lastname: Craven
authors.forename: Myron L
authors.initials: ML
authors.lastname: Weisfeldt
mesh_terms: D016887:Cardiopulmonary Resuscitation; D003159:Community-Institutional Relations; D030881:Disclosure; D004554:Electric Countershock; D004630:Emergencies; D004632:Emergency Medical Services; D028744:Ethics Committees, Research; D006297:Health Services Accessibility; D006323:Heart Arrest / Q000628:therapy*; D006801:Humans; D007258:Informed Consent; D012017:Referral and Consultation; D012106:Research; D012151:Resuscitation / Q000379:methods*