For more than two decades, emergency medical services (EMS) systems have proliferated primarily based upon governmental impetus and funding at the federal, state, and local levels. Although many of the foundations of patient care rendered in these systems have been based upon intuitive logic, the understanding of the impact on patient outcome is poor, at best. The reasons for the current status are varied, but five issues are preeminent:
1) The authority for the development of these medical systems has been based primarily in political and bureaucratic institutions which have little or no medical expertise;
2) Little attention has been paid to system evaluation, particularly in the area of cost-effectiveness;
3) Few academic medical institutions have become involved in EMS research;
4) Traditional approaches to medical research primarily are disease-specific and are not multidisciplinary. Thus these are not useful for evaluating and understanding the highly complex and uncontrolled environmental interactions that typify EMS systems; and
5) The process of efficiently and reliably collecting accurate data in the prehospital setting is extremely difficult.