Insufficient quality of research on prehospital medical emergency care--where are the major problems and solutions?

It is still unclear today whether a few minutes more or less spent in prehospital medical emergency care have a positive effect on a range of outcome variables. Modern emergency medical services (EMS) systems are expensive and have been introduced all over the industrialized world. Yet their effectiveness and efficiency are supported by scant scientific evidence. This is why research into EMS systems is urgently needed. There are significant differences between the approach to EMS research and traditional clinical research. New methodological approaches, such as system-orientated research and risk-adjustment measurements, must be further developed. The implementation of randomized controlled trials (RCTs) in the prehospital setting is often very difficult and not always possible or suitable. Valid alternatives to RCTs exist and should be further developed. Epidemiologists would be of assistance here. Agreement on clear definitions, standard data elements and validated severity scoring for trauma and non-trauma conditions, as well as their validation and routine use throughout the world are urgently needed. Clarifying many questions with regard to EMS systems cannot be left to chance. An internationally recognized research agenda with prioritisation and adaptation to regional requirements would be of great assistance here. Finally, reliable research in Switzerland into EMS enabling relevant decisions will hardly be possible without financial support from the Swiss National Fund and other institutions. Furthermore, it would be inappropriate to decrease the current standard of prehospital care we offer in the short term in order to save money as long as we have no reliable results that indicate that we should. This would also render impossible the very research into this sector that is urgently needed.