Index
Abstract
Dedication
Preface
Definition of EMS for this Document
Federal Agencies Can Help Advance EMS Research
Executive Summary

• Develop Researchers
• Facilitate Collaboration
• Establish a Reliable Funding Stream
• Establish Alternative Funding Sources
• Recognize The Need for EMS Research
• View Research as Necessary for the Improvement of Patient Care
• Create Reliable Information Systems
• Enhance Ethical Approaches to Research
• Conclusion

Introduction
History of EMS Research
The Present State of EMS Research
Overcoming the Barriers to EMS Research
Summary
Appendix A: The National EMS Research Agenda Writing Team
Appendix B: Organizations Invited to Participate in the National Review Team
Appendix C: Ethical Standards and IRB Requirements
Appendix D Inclusion Of Women And Minorities In Research Study Populations Involving Human Subjects
Inclusion Of Children As Participants In Research Involving Human Subjects
Appendix E: Bibliographic List of Internet Links
Appendix F: Published EMS Randomized Clinical Trials
References

Executive Summary

Imagine if you will, the public outcry that would ensue if a jumbo jet filled with passengers crashed every day in the United States. Regrettably, Americans no longer need to imagine disasters that result in the tragic loss of lives. However, each day, more people die of sudden cardiac arrest than would fill a Boeing 747.⁷ The most effective way to improve the odds of survival for sudden cardiac arrest is rapid defibrillation in the prehospital setting. As high quality Emergency Medical Services (EMS) developed during the 1970s, cardiac arrest survival rates increased from near nothing to about 20% in a few progressive cities.⁸ However, essentially no additional progress in survival from cardiac arrest has occurred since 1980.⁹ For children, the odds of survival remain abysmal. Less than 2% of children with prehospital cardiac arrest survive to leave the hospital.¹⁰

Trauma systems developed during the 1970s to address the inadequacy of care for victims of traffic crashes. EMS began to transport patients directly to regional trauma centers, often bypassing closer community hospitals. With the establishment of these regional trauma centers the odds of survival from motor vehicle crashes improved.¹¹ This reduction in mortality from injury illustrates the value of having EMS professionals who understand how to use the emergency care resources available in each community.

The vast majority of patients cared for by EMS, however, are not victims of cardiac arrest or major injury. They have illnesses or injuries that are not life threatening yet require access to medical care. EMS spends about five billion dollars each year, most of which is used for the provision of care to patients without life threatening conditions. Essentially no research has been performed to evaluate the effectiveness of EMS care for this group of patients.

Progress in prehospital emergency patient care is needed. There is not enough high quality EMS-related research to drive improvements in patient outcome, and vast amounts of money are being spent for patient care with little rigorous evaluation of the effectiveness of that care. Methodologically sound research must be incorporated into all facets of the EMS system. This document, the National EMS Research Agenda, discusses the reasons why EMS research is important and emphasizes that the responsibility for examining EMS practice lies with all stakeholders in EMS.

Performance of high quality EMS research is hindered by five impediments: 1) Paucity of highly skilled researchers; 2) Inadequate funding; 3) Failure of EMS professionals to understand the importance of conducting EMS research and translating the findings into clinical practice; 4) A lack of integrated information systems that provide for meaningful linkage with patient outcomes; and 5) Logistical problems in obtaining informed consent. However, these barriers can be overcome.