Prehospital Care

The emergence of emergency medical services (EMS) as a realm within emergency medicine (EM) has recently been completed, with EMS gaining status as a boarded subspe-cialty. While there are excellent journals and a rich literature addressing EMS and out-of-hospital care, we embraced, with enthusiasm, the invitation of the editors to coordinate an EMS-related special issue on prehospital Care. The open access and online nature of the offers a unique chance for widespread attention to EMS, at a time when that attention is particular a propos given the new focus associated with subspecialty status. As guest editors, we bring to the issue's review process over a century of experience in ground EMS, air transport, and disaster operations. Our backgrounds include experience with urban and rural ground and air EMS systems all over the U.S. and abroad. Our responsibilities include involvement with ground and/or air EMS care in the USA east coast (S. Dyer, of Boston University), the USA west (C. The breadth of interests from our collective background has translated into a similarly broad range of topics covered in this special issue on prehospital care. The solicitation of manuscripts allowed for virtually any topic within prehos-pital and out-of-hospital care, and the manuscripts received were a testament to the excellence of work around the world, in our chosen fields. We believe that the papers that were ultimately approved for publication in this special issue represent important contributions to the state of the evidence in EMS as follows. A paper focuses on an EMS angle of a subject that has become one of the most important rooms in the house of medicine: quality. In his review of clinical performance indicators, M. J. El Sayed outlines EMS's place in the dialogue about quality measurement. His overview provides background discussion, education, and practical direction for EMS services. Another article takes on a clinical conundrum facing acute care providers every day: what's causing this patient's dyspnea? J. E. Gough and K. L. Brewer address the differentiation of various causes of dyspnea-differentiation that can be tricky even in the hospital setting. The divergence of therapeutic approaches to varying dyspnea etiologies means that the earlier the true causes can be identified, the more rapidly patients can receive appropriately tailored therapy. In their pilot study, J. E. Gough and K. L. Brewer suggest that peak expiratory flow rate may provide useful clues to allow earlier differentiation of two major …