Oregon Health & Science University (OHSU) has the institutional experience, study team leadership, pre-existing emergency department (ED), and emergency medical services (EMS) research network framework to lead a successful hub for the Strategies to Innovate EmeRgENcy Care Clinical Trials Network (SIREN). The OHSU Hub is the top performer amongst all SIREN hubs, enrolling 203 patients across 4 trials. Our hub includes a geographically dispersed footprint consisting of 8 institutions across six regions, resulting in a productive hub covering a diverse patient population. The OHSU Department of Emergency Medicine (DEM) has been ranked in the top ten for NIH EM funding annually for over a decade.1 Our faculty team members are all federally funded (NIH/ DoD/ CDC/ AHRQ/ HRSA) physician-scientists with >30 years of multisite ED/EMS research experience. We will leverage our extensive experience to 1. Continue the OHSU Hub's strong participation and enrollment in SIREN trials through an expansive network of investigators, research staff, clinical collaborators, and other partners. 1a. Continue existing effective collaborations. We will nurture the positive and productive relationships between our 7 spokes, 25 EMS agencies, and multidisciplinary subspecialty panels. 1b. Develop new collaborations and methods to increase enrollment. Expand the OHSU Hub by adding regional sites to increase the number of patients enrolled in clinical trials. 1c. Optimize communication to ensure the conduct of high-quality trials. Implement a bi-level communication approach: a. Study-specific meetings of study PIs/staff to share best practices; and b. Quarterly meetings with spoke PIs and staff for effective team building. 2. Actively contribute to governance and science of the national SIREN network 2a. Participate in SIREN governance efforts. Our team has served on SIREN committees, Operations, EMS, and Cardiovascular, and will continue our strong participation in SIREN committees. 2b. Lead SIREN scientific efforts. We propose one SIREN EMS trial, present multiple trial concepts. 3. Train the next generation of multidisciplinary physician-scientists in emergency care research (ECR), focusing on clinical trials methodology and experiential learning through SIREN. 3a. Recruit junior faculty of diverse backgrounds at 8 university sites to engage in a structured mentor- guided research training experience with a focus on clinical trials in emergency care. 3b. Optimize experiential learning, training, and collaboration, integrate all scholars into SIREN activities, to learn the design, implementation, conduct, and analysis of clinical trials in emergency care. The OHSU Hub will leverage its past success to promote the SIREN goals: large recruitment strategy, minority inclusiveness, pipeline expansion of clinical trialists, and meet the changing needs of ECR.