This document, commissioned by the National Highway Traffic Safety Administration and the Maternal and Child Health Bureau, describes the history and current status of EMS research. Within its pages, impediments to the growth of scientific investigation in the field are identified; and strategies are suggested for improving the quality and quantity of EMS research with the goal of providing a scientific foundation upon which to base current and future prehospital care. We describe a culture of EMS that has been slow to respond to, recognize, and utilize the potential that exists in technology and science today. The time for major advancement in the science and practice of EMS is here. Emergency Medical Service providers must be able to deliver state of the art care based on sound scientific knowledge. A number of us, our families, or our friends will at some point turn to local EMS providers for assistance; and we expect that they will provide us with the best care possible.