Abstract.Multicenter clinical trials require approval by multiple local institutional review boards (IRBs). The Multicenter Airway Research Collaboration mailed a clinical trial protocol to its U.S. investigators and 44 IRBs ultimately reviewed it. Objective: To describe IRB responses to one standard protocol and thereby gain insight into the advantages and disadvantages of local IRB review. Methods: Two surveys were mailed to participants, with telephone follow-up of nonrespondents. Survey 1 was mailed to 82 investigators across North America. Survey 2 was mailed to investigators from 44 medical centers in 17 U.S. states. Survey 1 asked about each investigator's local IRB (e.g., frequency of meetings, membership), whereas survey 2 asked about IRB queries and concerns related to the submitted clinical trial. Results: Both surveys had 100% response rate. Investigators submitted applications a median of 58 days (interquartile range [IQR], 40-83) after receipt of the pro-

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The theme of the 14th annual Academic Emergency Medicine consensus conference was "Global Health and Emergency Care: A Research Agenda." The goal of the conference was to create a robust and measurable research agenda for evaluating emergency health care delivery systems. The concept of health systems includes the organizations, institutions, and resources whose primary purpose is to promote, restore, and/or maintain health. This article further conceptualizes the vertical and horizontal delivery of acute and emergency care in low-resource settings by defining specific terminology for emergency care platforms and discussing how they fit into broader health systems models. This was accomplished through discussion surrounding four principal questions touching upon the interplay between health systems and acute and emergency care. This research agenda is intended to assist countries that are in the early stages of integrating emergency services into their health systems and are looking for guidance to maximize their development and health systems planning efforts.ACADEMIC EMERGENCY MEDICINE 2013; 20:1278-1288© 2013 by the Society for Academic Emergency Medicine A chieving the highest attainable standard of health requires universal access to essential services that are rationally distributed and utilized. Timely action in response to emergent disease presentations is one such essential health service. At present, many national health systems are oriented to specific diseases rather than cross-cutting "systems" interventions that might have a larger long-term effect by strengthening systemwide capacity. The natural history and epidemiology of emergencies emphasize that highly functional health systems, including intact and codified referral networks, are necessary to improve survival of patients with acute diseases. Failure to prioritize integration across disease-oriented programs and service delivery units, and failure to deliver emergency health services promptly, results in care that is poorly coordinated and poorly applied (e.g., delays in treating sepsis with antibiotics leading to death or disability). Such fragmentation of care reduces the disease burden that can be addressed with a given set of resources. Integration of emergency services has the potential to improve outcomes with fixed resource inputs by improving both organization of services and efficiency of service delivery. Given the nature of the problem, consensus is necessary both to define and to prioritize health problems and to decide which services are essential. Expert consensus conferences may usefully establish the boundaries of common understanding and determine which questions require further investigation; saving lives in times of emergency thus depends on action that is informed by consensus, validated by research, and executed in a standardized manner.,This article presents the research recommendations developed during the breakout session on global emergency care and health systems at the Academic Emergency Medicine consensus ...