• prehospital care

Prehospital care is a developing and exciting area of emergency practice. It comprises a variety of emergency care domains, including ambulance and emergency medical services (EMS) practice, medical rescue, prehospital physician response and medical direction, retrieval medicine, (including aircraft and seaborne activities), dispatch and communications, telemedicine, disaster medicine. Increasingly, there is greater interaction between various emergency authorities, including fire service, police, civil defence, military authorities. Greater interaction with hospital emergency departments is also being encouraged.

The major problem has been auditing the effectiveness of prehospital care and whether it is cost effective, or even worth the effort at all! Strong emotions and forcible opinions exist among both supporters and detractors.

The fundamental problem has been the lack of evidence based assessment of prehospital practice. The paucity of prehospital care in Cochrane reviews is evidence of this. A fundamental part of the problem has been the lack of reliable indicators to measure effectiveness, commonly because of the large variety of variables operative in this area. Attempts have been made to develop indicators, mainly in North America,^1–3 but there has not been general acceptance of appropriate indicators. In many EMS systems response times and …