“What are your burning questions?” asked Jeremy Brown, MD, director of the Office of Emergency Care Research (OECR) at the National Institutes of Health (NIH).

Speaking at ACEP14, Dr. Brown described the relatively new NIH office and called on emergency physicians to pose scientific questions. “If emergency medicine is alive as a scientific endeavor, we must have research problems of our own that need to be solved, and are solvable given what we already know,” he said, adding the need for physicians to help clearly articulate the problems.

The creation of OECR followed a 20-year journey that included an NIH request (2008-2009) for information on current needs in emergency medicine research. The request prompted three roundtable discussions and a laundry list of the problems that present to the emergency department (he referenced these articles: Summary of NIH Medical-Surgical Emergency Research Roundtable Held on April 30 to May 1, 2009; NIH Roundtable on Emergency Trauma Research; NIH Roundtable on Opportunities to Advance Research on Neurologic and Psychiatric Emergencies.

In 2012/2013 OECR was created by an Act of Congress with the following missions:

• Catalyze the development and refinement of existing research portfolios.
• Coordinate research that involves multiple NIH institutes and centers.
• Create ways to fund new research.
• Train the next generation of clinicians researching emergency care.

Currently, emergency department awards rank 30^th out of 44 research categories, with regards to NIH funding. Specifically, in 2013, emergency medicine departments received $36.2 million in awards. That number excludes training (K) awards and awards to principal investigators who are not based in EDs, but who study emergency care questions. Dr. Brown acknowledged, however, that the $36.2 million figure does not tell the whole story and that calculating how much NIH spends on emergency care research is difficult.

Another way to look at funding is to use the NIH Research, Condition, and Disease Categorizations (RCDC) tool. RCDC is a computerized process that makes it possible to determine the amount of money spent by NIH in a given category. Categories can be proposed by Congress or can be created by NIH staff. Current categories included scleroderma, which has received $24 million in funding from NIH, and West Nile Virus, which has received $29 million in funding from NIH. RCDC is designed such that the same amount of money can be counted twice or three times if it can be tagged in multiple categories. Consequently, as Dr. Brown pointed out, “You have to be careful how you use this data.”

When Dr. Brown took over at OECR, there was no RCDC code for emergency medicine. Absent an RCDC code, there was no way to know how much NIH spent on emergency care research. He created an RCDC code for clinical emergency medicine and calculated that in 2011, 2012, and 2013, NIH spent a total of $90.8 million, representing 2.6% of NIH funding.

Dr. Brown concluded his talk by explaining that OECR wants to fund more excellent science.

“We are lagging behind,” he said. “We need to do something about this.”

Lara C. Pullen is a freelance medical writer in Chicago.