The provision of prehospital care has come under increased scrutiny in recent years. Although it is acknowledged that timely transport is necessary for some patients, many have questioned the value of the range of prehospital care services currently provided (Callaham, 1997; Koenig, 1995, 1996; Reines et al., 1988; Smith et al., 1985; Spaite et al., 1995). In the broader healthcare community, there is a persistent concern about the lack of proof of effectiveness related to most prehospital care (Raskin, 1991; Relman, 1988; Roper et al., 1988). Most experts on both sides of the argument agree that methodologically sound outcomes research that identifies "what works" in prehospital care is long overdue (Callaham, 1997; Delbridge et al., 1998; NHTSA, 1996, Spaite et al., 1997; Brice et al., 1996; Spaite, 1993).
In 1994, NHTSA convened a workshop on methodologies for "measuring morbidity outcomes in EMS." The experts in this workshop concluded that implementation of EMS outcomes research was essential (NHTSA, 1994). However, it was noted that the methods applicable to prehospital outcomes, especially those using non-mortality measures, had never been developed. These methods should be applicable across the entire spectrum of the "Six Ds " of patient outcomes: Death (survival); Disease (impaired physiology); Disability; Discomfort; Dissatisfaction and, Destitution (cost) [NHTSA, 1994]. In response to these conclusions, a five-year cooperative agreement, the Emergency Medical Services Outcomes Project (EMSOP) was funded to facilitate EMS outcomes research and to implement the recommendations from the workshop of 1994.
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