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

• EMS Impact
• Is EMS Cost-effective?
• Need for Outcome Measurement
• Organized Research Effort Needed

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

EMS Impact

While precise numbers are not available, EMS treats and transports approximately 25 to 30 million patients per year. As an important point of entry into the healthcare system, EMS is in a unique position to impact those patients. It is logical to assume that prehospital intervention positively affects patient outcome, but this influence is difficult to quantify. For example, early defibrillation to victims of sudden cardiac arrest,¹³ administration of nitroglycerin to patients with chest pain,^14,15 and prehospital administration of fibrinolytic therapy to patients with myocardial infarction¹⁶ measurably saves lives. On the other hand, seemingly logical interventions such as the pneumatic anti-shock garment¹⁷ and endotracheal intubation of children¹⁸ may in fact cause harm. That so few EMS interventions have been subjected to outcome studies illustrates the lack of evidence for most prehospital therapies. More research is necessary to provide the evidence upon which EMS practices can be based.

Misperceptions about EMS on the part of the public abound. In one study, fifteen percent of the patients in a hospital emergency department thought that paramedics were physicians.¹⁹ The entertainment media routinely depict cardiopulmonary resuscitation as resulting in good patient outcome, likely leading to unrealistic expectations among the lay public.²⁰ Most members of the public believe that the use of warning lights and sirens saves clinically significant time in ambulance response and transport to the hospital, although several studies have suggested otherwise.^21,22 No one has published an evaluation of the public’s perception of the importance of EMS research or the impact of research (or the lack thereof) on EMS practices.