trauma care research is concerned with the treatment of these patients in the prehospital and hospital settings, but it reaches further into the inpatient setting, particularly the intensive care unit (ICU) and surgical departments. This chapter focuses primarily on research in the area of prehospital EMS, including prehospital trauma care.

Currently, a range of federal government agencies each contribute relatively small amounts of funding to prehospital EMS research. The National Institutes of Health (NIH), the Agency for Healthcare Research and Quality (AHRQ), the National Highway Traffic Safety Administration (NHTSA), the Health Resources and Services Administration (HRSA), and the Centers for Disease Control and Prevention (CDC) all have programs in place to support research in this area. But while the federal government dedicates tens of billions of dollars each year to health-related research, a tiny percentage of that funding is directed to emergency care research in general and prehospital emergency care in particular. The primary foundation-based supporters of emergency care research training are the Emergency Medicine Foundation (EMF), affiliated with the American College of Emergency Physicians (ACEP), and the Society for Academic Emergency Medicine (SAEM). However, both of these programs are quite small, allocating less than $1 million per year combined, and only part of that to EMS.

AN INADEQUATE RESEARCH BASE TO SUPPORT EMS

Despite the size, scope, sophistication, and critical role of EMS in the United States, the evidence base to support EMS-related clinical and system design decisions is much less well developed than that in other areas of medicine (NHTSA, 1996). Consequently, EMS has for years operated without a sufficient scientific basis to support many of its actions (NHTSA, 2001a; McLean et al., 2002; Sayre et al., 2003).

Policy makers and experts in the field have long recognized the paucity of information relating to EMS, and there have been numerous efforts to expand this research base. The 1996 Emergency Medical Services Agenda for the Future, developed by NHTSA’s Office of EMS together with HRSA, focused on the importance of research and evaluation and the need for robust data and information systems (NHTSA, 1996). The 1998 Emergency Medical Services Agenda for the Future: Implementation Guide identified the creation of a national EMS research agenda as a key priority (NHTSA, 1998). The Implementation Guide also stressed the importance of developing academic institutional commitments to EMS-related research and forming collaborative relationships among EMS systems, private foundations, medical schools, and other academic institutions.

In 2001, NHTSA and the Maternal and Child Health Bureau within HRSA released the National EMS Research Agenda. The report presented



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