FOEM

I am a...*

First Name*

Last Name*

E-Mail Address*

Phone*

Name of Organization or Institute*

Name of Organization or Institute* (If your Organization is not found here, you will need to submit an application to the FRN network.)

Your organization is already registered with the FRN Network. Click the Register button below to request access.

Please fill out the form below to submit your site and research opportunities to our database.

Your information will be sent to our administrators for approval before your opportunities will be listed on the FRN Network.

Location Specifics

Location Information*

Location Information

Name of Institution*

University Affiliation*

Address*

Suite/Unit

City*

State*

Zip*

Contact Information

EM Residency Director

Name:

Email:

EM Residency Coordinator

Name:

Email:

EM Residency

Name:

Email:

Location Specifications

Base hospital bed size:

Does ED have electronic medical record?:

Yes No

Obstertrics service?

Annual Volume

Yes No

Cardiac catheterization with PCI?

Annual Volume

Yes No

Is your hospital a member of AHA/ASA Get with the Guidelines Program?

Yes No

Pediatric admissions

Annual Volume

Yes No

PICU?

Annual Volume

Yes No

Designated Stroke Center

Yes No

Number of CVA's treated annually

Ischemic

Bleeds

Number of thrombolytics given annually

Neuro-endovascular service available?

Yes No

Hypothermia for cardiac arrest survivors available?

Yes No

ECMO available?

Yes No

ED visits annual volume

Fast Track volume

Pediatric Track volumes

Trauma Center Designation

Level 1

Level 2

Yes No

Hospital postgraduate training programs (check all that apply)

Residencies

Urology

Nuerosurgery

Ortho

Surgery

HEENT

EM/IM

Ob/Gyn

Psych

Peds

Neuro

Other

Fellowships

Cardiology

Geriatric

EMS

Pulm/Crit-Care

PEM

Tox

OMM

Trauma

Radiology

Other

Yes No

Has your institution participated in a single or multi centered trials in the past?

If Yes, please list the titles and funding source for your institutions last three research studies complete:

Do you have an IRB at your institution?

Yes No

Does your EM residency have a Research Director?

Yes No

Is there an EM research rotation available for visiting medical students at your institution?

Yes No

Optional Statistical Questions

If easily available please estimate the number of patients your hospital treats annually by discharge diagnosis. We are starting with the limited list below initially to address research opportunities created by the new FRN partnership with the American Heart association/American Stroke Association.

STEMI

Ischemic CVA

DVT

NSTEMI

TIA

CHF

Hemorrhagic CVA

Pulmonary Embolus

Atrial Fib

Available Research Opportunities

Research Opportunity #1

Project Title*

Start Date*

End Date*

Provide a brief description of the project.* Provide contact information.*

Types of Researchers

Students

Residents

Physicians

Other

Select Research Focus

Administrative

Cardiology

Controlled Substance

Critical Care

EMS

Ethics

Geriatrics

Infection Disease

Legal

Neurology

OB/Gynecology

OMM

Other

Our Role in Combating Antibiotic Resistance

Pain Management

Pediatrics

Pulmonary

Radiology

Risk Management

Sports Medicine

Surgery

Toxicology

Trauma

Wellness

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FOEM RESEARCH NETWORK

Connecting you with medical research opportunities

Researcher

Research Site User

Clinical Research Organization User

Location Specifics

Location Information

Contact Information

EM Residency Director

EM Residency Coordinator

EM Residency

Location Specifications

Optional Statistical Questions

Available Research Opportunities

Research Opportunity #1

Types of Researchers

Select Research Focus

Add Another Research Opportunity