Striving for the Best Possible Systems: A Conversation with E. Brooke Lerner, PhD

E. Brooke Lerner, PhD, FAEMS, co-principal investigator for the Pediatric Emergency Care Applied Research Network’s (PECARN)’s dedicated EMS research node – CHaMP E-RNC (Charlotte, Houston, Milwaukee Prehospital EMS Research Node Center) – has committed her career to improving prehospital outcomes.

Since being diagnosed with stage 4 pancreatic cancer, she has continued to build her legacy. She took time to speak with us about her career, progress she’s seen, and her hopes for the field.

How did you get involved with EMSC?

"I wanted to go to medical school, so I went through EMT training, then found a job in the City of Buffalo as an EMS provider. I became involved in a research project and fell in love with the process. I began to question, as an early-career EMS provider, how I would know certain things — for example, how to get people to a trauma center.

One telling experience was when we received a call about a kid who tried to jump a train and missed. I happened to be working with a medic who usually flew, and even though we were in the middle of Buffalo, we had traveled a good distance off road to reach the patient. So the medic decided we should use the helicopter because this kid had hurt his back and the trip out was going to be dangerous. It really got me thinking: if he hadn’t been there, would anyone have thought to do that? How do we teach people the things that experience can teach you? How do we make the person who’s on their first shift as good as the person who’s on their last shift?

A lot of those answers can come through research. EMSC was really one of the first places that had funding for EMS research, which allows you to make EMS better for all patients."

How did you get involved with PECARN?

"In the first round of PECARN, Rochester, New York, was a site, and that’s where I was. I was recruited by what is no PEM-News [Pediatric Emergency Medicine Northeast, West and South] to help incorporate EMS into what they were doing. I began working with Peter Dayan, the principal investigator for PEM-NEWS, to try to make a registry of EMS data, and that’s where we learned how hard it was. Eventually HRSA [Health Resources and Services Administration] put out the call for an EMS-only node, and Manish Shah [co-principal investigator for CHaMP] and I decided we should apply and were lucky enough to get it. At that time, it was a Targeted Issues grant and not an official PECARN grant, so we got that twice and then it converted to an actual PECARN grant in this last round."

How did you first become interested in attending medical school and EMS?

"My grandpa and I watched Emergency! when it was on TV, so it’s always appealed to me. It fits my personality and interests. It was an honor to be in EMS. People allow you to enter their homes on their worst day and let you see everything about their life. Working in EMS felt like I was making an important contribution to my community. It’s a role that most people don’t understand or realize how important it is until they need it. Good EMS can give you a better outcome in a bad situation, and it’s exciting to be a part of that."

You've done ground-breaking work with trauma triage; you received the top award from National Association of EMS Physicians. What work are you most proud of when you look back at your career?

Many people who like emergency medicine like the fact that every day is different, and you never know what’s coming next. I was able to have tons of different experiences and make real contributions and see things change over time – and that is what I am most proud of. Being just a piece of all that change is incredible. Helping more PhDs and other professionals be able to continue to pursue EMS research has been an honor.

You’re still working on some research projects. What are those projects, and what do you think their impact might be?

"I’m super excited that Manish’s PediDOSE study was funded, and I am very happy to serve as a co-investigator on that project. Matt Hansen’s [another CHaMP researcher] asthma project is about to get funded, and we’re going to be a site for that. I’m trying not to start anything new; I’m working a lot with students and young faculty more than pursuing my own research."

What are the biggest gaps you still see in pediatric prehospital research – the areas where you think, “I just want to move the needle on these things”?

"There are still tons of things that haven’t been explored or looked at, and it’s the creativity of the people who are passionate about those questions that’s important. My big interests have been trauma triage and disaster preparedness. I always tried to find ways to identify the kids who could receive treatment where they were and to identify the kids who needed more specialized care and how to get them to that care; I think it’s important to try to avoid expensive and dangerous modes of transport. That’s my interest, but I think it’s vital for people to work in areas they are passionate about. There is still lots of work to be done, but the key is to work where you have passion — not where someone tells you there’s a gap."

How do you see us making progress in translating research?

That is the $1 million question, right? It really is amazing to see how slow things change. I understand that consensus-based guidelines don’t feel great, but they do move the research forward because they identify the gaps. I think convincing people to trust those processes — and working to have those processes trustable — is key. A lot of times, questioning of the guidelines and protocols leads to things not being the same everywhere and not being translated. So a big part of it is to formalize these processes, which I think we’ve done a much better job of, and get that information out there and get people to trust in those systems and incorporate them a little easier. It’s good that we question everything. At the same time, we really need to find a way to decide what we’re going to do and offer the same great care to everyone.

What do you hope for the future of pediatric prehospital research?

"I hope we keep doing it, and the government keeps investing in it. I hope we keep finding ways to incorporate it into practice and ensure that any child who accesses the 911 system has the same access to care and the same quality care as other children, and we just keep improving and striving for the best possible systems."

What advice would you give to an early-career researcher entering the field of pediatric prehospital care?

"Stay with it. Research is about a lot of rejection, and I sometimes wish I had kept track of all my rejections because I think my CV is misleading. It just shows the success and not all the failure that came before. Embrace the failure, keep moving, and everything will turn out just fine."

As you navigate your diagnosis, how can your colleagues at EMSC and beyond best support you and honor you?

"People have been very kind and supportive. This question is why I worked with NAEMSP to create to research fund, to give people a place to put their support of me and their love of EMS. That, to me, feels very meaningful."

Learn more about the E. Brooke Lerner Research Fund or learn about PECARN.