BOX 1-1

The Six Quality Aims of the Institute of Medicine’s Quality Chasm Report

Health care should be:

  • Safe—avoiding injuries to patients from the care that is intended to help them.

  • Effective—providing services based on scientific knowledge to all who could benefit and refraining from providing services to those not likely to benefit.

  • Patient-centered—providing care that is respectful of and responsive to individual patient preferences, needs, and values and ensuring that patient values guide all clinical decisions.

  • Timely—reducing waits and sometimes harmful delays for both those who receive and those who give care.

  • Efficient—avoiding waste, including waste of equipment, supplies, ideas, and energy.

  • Equitable—providing care that does not vary in quality because of personal characteristics such as gender, ethnicity, geographic location, and socioeconomic status.

SOURCE: IOM, 2001, pp. 5–6.

uncontrolled situations (Franks et al., 2004). Moreover, they can be exposed to potentially infectious bodily fluids and airborne pathogens. In addition to these dangers, crashes involving ground ambulances are a major concern; according to the Centers for Disease Control and Prevention (CDC), 300 fatal crashes involving ambulances occurred in the United States between 1991 and 2000 (CDC, 2003).


As noted above, there is very limited evidence about the effectiveness of many EMS interventions. Although there have been a small number of landmark studies in EMS, for the most part the knowledge base is quite limited. As a result, patients cannot be certain that they will receive the best possible care in their encounters with the EMS system. Questions related to core aspects of current clinical EMS practice remain unresolved, and EMS personnel must often rely on their best judgment in the absence of evidence. Not infrequently, treatments with established effectiveness and

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