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

• Primary Barriers: Developing Researchers
• Primary Barriers: Funding
• Secondary Barriers: Recognizing the Need for EMS Research
  • The Culture of EMS
  • EMS Systems
  • EMS Education
  • The Public and Policy Makers
  • EMS Professionals
• Secondary Barriers: Information Systems
  • Data Definitions
  • Hardware and Software Infrastructure
  • Data Set Linkages
  • Statistical Implications of Large Databases
• Secondary Barriers: Ethical Concerns
  • Principles
  • Informed Consent
  • IRBs and EMS Research
  • Valuing Individual Autonomy

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

Data Definitions

An example may help to make this clear. A researcher who is interested in the care of victims of motor vehicle crashes would like to know the total time interval from the occurrence of a crash until the driver arrived at the hospital. This researcher wishes to compare patients in suburban areas with those in rural areas. Since the time of the crash is not recorded automatically, the researcher decides to use the time that the first person called 911 as a surrogate marker for the time of the crash. In one community, the computer aided dispatch system saves the time at which a call begins to ring at the public safety answering point and labels that data point as the “911 call time”. In another community, the computer aided dispatch system records the time at which the call is answered by the EMS dispatcher after the call was transferred from an operator at the public safety answering point. That agency also uses the label “911 call time”. A researcher who did not know the specific mechanisms for collecting and labeling data used by these two EMS agencies could be easily misled into thinking that both agencies were recording the same event, when in fact these are two distinct time points.

Clinical research activities have been enhanced by efforts to standardize prehospital data acquisition. Standardized templates and definitions for the reporting of prehospital cardiac arrest data have been developed.⁸⁴ Similar reporting standards have been developed for pediatric cardiac arrest⁸⁵ and trauma data.⁸⁶

There are two major federally sponsored data definitions that describe data points that could be collected on each patient encounter. These are the Uniform Prehospital Data Elements developed by NHTSA⁸⁷ and the Data Elements for Emergency Department Systems (DEEDS) developed by the Centers for Disease Control.⁸⁸ The development of the Uniform Prehospital Data Elements and Definitions in 1993 was a crucial step to structure evidence about the efficacy of prehospital care.⁸⁷ Sadly, few EMS systems have adopted these criteria; and most agencies are still unable to link prehospital data with outcome information. Only 25 states require EMS provider agencies to use most or all of these data elements. The DEEDS document was developed by the Centers for Disease Control to address the same data labeling issues for emergency department encounters.⁸⁸ Despite evidence that these data-standardization tools may not be used to their full potential, their existence is encouraging.⁸⁹

Widespread use of both the DEEDS data definitions and the Uniform Prehospital Data Elements would enhance EMS research. The challenge is in convincing EMS agencies to embrace a new system. While administrators may benefit from the ability to advance the quality improvement process and perform system benchmarking, implementation of these systems is costly. At this time, there is not a compelling advantage to using the newer systems for those actually providing care to patients.