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

A Case Study In EMS Research

The experience with the pneumatic anti-shock garment (PASG) is illustrative of the early research experience in EMS. Many EMS physicians promoted its use in a wide variety of medical and surgical conditions with little evaluation of its effectiveness,47,48 while others were less convinced of its value.49 PASG use became widespread, with many jurisdictions requiring them as minimal equipment for ambulances at an expense of several thousand dollars per vehicle. Several years after gaining acceptance as a standard item to be stocked on ambulances, a single, randomized clinical trial found that application of the PASG to victims of truncal penetrating trauma in an urban environment actually worsened patient outcome.50 In the wake of that study, the popular sentiment rapidly shifted to renounce the use of the PASG. Yet, a comprehensive review of the literature established that some patients might in fact benefit from use of the PASG.17 This is but one example in which misinformation and the lack of scientific knowledge about optimal patient care has confused clinicians and left them floundering to provide the best care without the guidance of good science.

Decisions about the effectiveness of any intervention must be based upon reliable evidence. This requires that there be enough studies to provide sufficient information upon which, among other things, effectiveness and generalizability of the intervention can be determined. Due to the paucity of available research, EMS decision makers have been forced to make judgments based upon limited evidence. Two current issues in which this problem is readily apparent are pediatric airway management, where one controlled trial has questioned the efficacy of endotracheal intubation;18 and the use of amiodarone for cardiac arrest, where another randomized controlled trial has suggested a positive effect.51 While both of these studies are examples of methodologically sound research and add to the overall understanding of their respective issues, additional high quality investigations are needed.