FWAs with community hospitals to procure patient-level outcome data from a low-risk EMS study.

Limited Federal Research Funding

The U.S. federal government expends tens of billions of dollars each year on health-related research, including clinical trials and other research examining health care services and treatment guidelines. However, a small share of available research dollars is directed to emergency and trauma care, and even less to prehospital care in particular. This situation has contributed to a dearth of evidence regarding which interventions produce positive outcomes in the prehospital environment.

National Institutes of Health

NIH is the largest single source of support for biomedical research in the world, with a budget of over $27 billion in 2004 (IOM, 2004). NIH includes 20 Institutes, 7 Centers, and 4 Program Offices contained within the Office of the Director. All Institutes but only some of the Centers provide research funding, while several other Centers provide general support (e.g., the Center on Scientific Review). All Institutes and 4 of the Centers receive individual congressional appropriations.

The NIH Institutes are organized into five categories: disease, organ system, stage of life, scientific discipline, and profession or technology (IOM, 2003). None of the current Institutes or Centers are defined either by the site of care or the timing or urgency of care, which are the defining characteristics of emergency and trauma care research. NIH does not have an Institute or Center focused specifically on emergency services. Thus, many important emergency care–related clinical questions extend beyond the domains of single NIH Institutes or Centers. Although both a 2003 Institute of Medicine report (IOM, 2003) and the NIH Roadmap Initiative (Zerhouni, 2003) emphasized the importance of stimulating and funding trans-NIH research, the fact that EMS and emergency care research questions naturally span the domains of multiple Institutes and Centers has not been effectively addressed.

Agency for Healthcare Research and Quality

AHRQ is another federal agency charged with supporting health services research, though on a much smaller scale than NIH. It is estimated that NIH spends approximately $800 million annually on health services research, while the entire AHRQ budget is only approximately $300 million (IOM, 2003).

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