title: Global Health and Emergency Care: Overcoming Clinical Research Barriers.
abstract: OBJECTIVE
  There are many barriers impeding the conduct of high-quality emergency care research, particularly in low- and middle-income countries. Several of these barriers were originally outlined in 2013 as part of the Academic Emergency Medicine Global Health and Emergency Care Consensus Conference. This paper seeks to establish a broader consensus on the barriers to emergency care research globally and proposes a comprehensive array of new recommendations to overcome these barriers.
  
  
  METHODS
  An electronic survey was conducted of a purposive sample of global emergency medicine research experts from around the world to describe the major challenges and solutions to conducting emergency care research in low-resource settings and rank them by importance. The Global Emergency Medicine Think Tank Clinical Research Working Group at the Society for Academic Emergency Medicine 2016 Annual Meeting utilized a modified Delphi technique for consensus-based decision making to categorize and expand upon these barriers and develop a comprehensive array of proposed solutions.
  
  
  RESULTS
  The working group identified four broad categories of barriers to conducting emergency care research globally, including 1) the limited availability of research personnel, particularly those with prior research training; 2) logistic barriers and lack of standardization of data collection; 3) ethical barriers to conducting research in resource-limited settings, particularly when no local institutional review board is available; and 4) the relative dearth of funding for global emergency care research. Proposed solutions included building a diverse and interdisciplinary research team structured to promote mentorship of junior researchers, utilizing local research assistants or technologic tools such as telemedicine for language translation, making use of new tools such as mobile health (mHealth) to standardize and streamline data collection, identifying alternatives to local institutional review board approval and the use of community consent when appropriate, and increased advocacy for global emergency care research funding.
  
  
  CONCLUSIONS
  Significant barriers to the conduct of high-quality global emergency care research persist, and innovative strategies need to be adopted to promote and grow the field of global emergency care research. This paper provides a global consensus on the most important barriers identified, as well as recommendations for cost-effective strategies for overcoming these barriers with the overall goal of promoting high-quality research and improving emergency care worldwide.
authors.affiliation: Department of Emergency Medicine, Warren Alpert Medical School of Brown University, Providence, RI.
authors.forename: Adam C
authors.initials: AC
authors.lastname: Levine
authors.affiliation: Department of Medicine, Section of Emergency Medicine, Baylor College of Medicine, Houston, TX.
authors.forename: Meagan A
authors.initials: MA
authors.lastname: Barry
authors.affiliation: Department of Emergency Medicine, Yale School of Medicine, New Haven, CT.
authors.forename: Pooja
authors.initials: P
authors.lastname: Agrawal
authors.affiliation: Division of Emergency Medicine, University of Washington School of Medicine, Seattle, WA.
authors.forename: Herbert C
authors.initials: HC
authors.lastname: Duber
authors.affiliation: Department of Emergency Medicine, University of Texas at Southwestern Medical School, Dallas, TX.
authors.forename: Mary P
authors.initials: MP
authors.lastname: Chang
authors.affiliation: Department of Medicine, Section of Emergency Medicine, Baylor College of Medicine, Houston, TX.
authors.forename: Joy M
authors.initials: JM
authors.lastname: Mackey
authors.affiliation: Department of Emergency Medicine, Johns Hopkins University School of Medicine, Baltimore, MD.
authors.forename: Bhakti
authors.initials: B
authors.lastname: Hansoti
mesh_terms: D003625:Data Collection / Q000592:standards*; D003697:Delphi Technique; D004632:Emergency Medical Services; D004635:Emergency Medicine; D014943:Global Health / Q000191:economics*; D006302:Health Services Research / Q000191:economics / Q000941:ethics; D006801:Humans; D011795:Surveys and Questionnaires; D000078329:Workforce