Primum non nocere--first do no harm: an imperative for emergency medical services.

Unlike the response to landmark studies in other disciplines of medicine, the few existing controlled, randomized EMS studies have not led to any calls for "moratoriums" on the practices in question. Why haven't they? It is all too easy to continue to dismiss the negative results of studies from a system other than our own. The paramedics in the system studied were not as well trained, were not as closely supervised, or did not have adequate medical oversight; the study was flawed, etc. Any or all of these variables may be true. A particular system may be safely performing one of the practices in question. However, the published results of any study that finds a high-risk practice to be more harmful than beneficial should immediately mandate the close examination of the practice in each and every system. To do otherwise is in direct conflict with the mission of EMS, and minimizes the value of the lives of the people in the communities who depend on us. First do no harm... is anyone listening?