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

Hardware and Software Infrastructure

The computer revolution is happening in medicine. The Health Insurance Portability and Accountability Act of 1996 (HIPAA) will prompt a massive investment in electronic documentation. The regulations implementing HIPAA require additional security measures for medical record information, including medical records held by EMS agencies. Research review is permitted under these regulations, but HIPAA imposes new requirements in addition to existing privacy regulations. See the Code of Federal Regulations 164.514(i) for additional information.

Most EMS agencies and emergency departments still use paper records with multiple copies. Paper records present many problems for researchers. Both the originals and the copies are often illegible. Some of the time points recorded, which may be considered as hard data by researchers, are actually estimates by the caregivers.⁹⁰ If a patient is transferred between hospitals, the paper records may not make the trip with the patient.

Electronic medical record systems are being developed for use in emergency medicine and EMS. However, the design of these products will unquestionably affect the quality of the data. If the products are cumbersome to use, then the health care providers operating them may provide incomplete data in order to simply achieve their immediate goal of completing the data entry process.⁹¹ As the process of product development continues, software designers will likely incorporate standardized data definitions like the DEEDS data dictionary and the Uniform Prehospital Data Elements. So, as less documentation is done on paper and more is automated, the use of these established data definitions will increase and the ability of EMS researchers to abstract patient data will be enhanced.