Orange County EMS agencies in California eliminated pediatric intubation from the scope of paramedic practice.

To counter the considerable lack of data available to support specific medical interventions conducted in the field by EMS personnel, EMS professionals and policy makers at all levels should work to establish a culture of science-based decision making. In addition to specific clinical interventions, scientific evidence should be used to support systems-level decisions such as the appropriate level of training of responders, the proper deployment of new technologies, the utilization of EMS resources, and the optimal use of medical direction within EMS systems.

KEY BARRIERS TO EMS RESEARCH

The capacity to investigate key clinical and systems issues in EMS is limited by a variety of factors, including a lack of trained investigators having elected to focus their work on this area of medicine, legal and regulatory barriers that limit the number of qualified research subjects and the sharing of research-related information, and a lack of funding directed specifically to support EMS research. In addition, the infrastructure to support EMS research is lacking in many ways. Existing information systems present a number of problems related to data storage and retrieval (NHTSA, 2001a). For example, data definitions used by different EMS agencies and hospitals often differ, which makes compiling research data more difficult. In addition, most EMS programs continue to use pen-and-paper records, which introduces problems such as illegibility, gaps in information, and estimated data (e.g., time points). This problem may be exacerbated because most EMS personnel in the field do not consider themselves part of the research process and may resent any added paperwork requirements. The move to electronic data collection and more passive forms of data gathering might help alleviate this problem.

Even before the enactment of the Health Insurance Portability and Accountability Act (HIPAA; see below), researchers had difficulty in obtaining patient-level data from hospitals and other health care facilities. In general, hospitals have been reluctant to provide such information, in part because of the resources required to organize and collect the data, and more important because of fear of how the information might be used. With or without the restrictions HIPAA places on data sharing, EMS agencies would need to build trust with hospitals to facilitate this type of research work.

The complexity of the various agencies and personnel that deliver out-of-hospital care also hinders EMS research. Spaite and colleagues (1995) noted that component research, the cornerstone of “traditional” medical research, is characterized by focused, directed questions, with small numbers of data points that are easily obtained by small numbers of data collectors



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