Читать книгу Emergency Medical Services - Группа авторов - Страница 2

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2  Volume I Title Page Copyright Page Contributors Foreword Preface References About the Companion Site CHAPTER 1: History of emergency medical services Before 1966: Historical Perspectives 1973–1978: Rapid Growth of EMS Systems 1978–1981: EMS at Midpassage 1996‐2008: The Role of the Federal Government Matures, the United States Faces Terrorism, and EMS is at the Breaking Point 2009–2020: A Period of Incremental Progress EMS Agenda 2050 Acknowledgment References SECTION I: Airway CHAPTER 2: EMS airway management: system considerations The skills of airway management:an illustrative vingnette Introduction Challenges of airway managementin the field Airway management protocol development and equipment selection Quality management Research References CHAPTER 3: Airway procedures Introduction Personal protective equipment during airway interventions Basic airway interventions Noninvasive positive‐pressure ventilation Surgical airways Confirmation of airway placement Methods for securing endotracheal tubes and supraglottic airways Drug‐facilitated intubation Conclusion References CHAPTER 4: Airway management: special situations Introduction Ground‐level airway management Face‐to‐face intubation Intubating under low light conditions Minimizing airway management equipment Telemedicine‐assisted airway management Airway management in the tactical setting Pandemic airway management Conclusion Acknowledgment References SECTION II: Breathing CHAPTER 5: Respiratory distress Introduction Prehospital assessment and diagnosis General treatment Summary References CHAPTER 6: Oxygenation and ventilation Introduction Assessment of Oxygenation Assessment of Ventilation Assisting Oxygenation and Ventilation Noninvasive Positive‐Pressure Support Bag‐Valve‐Mask Ventilation Mechanical Ventilation Summary References SECTION III: Circulation CHAPTER 7: Hypotension and Shock Introduction Pathophysiology Evaluation Additional Modalities to Assess Shock Treatment Shock Interventions Controversies Protocol Conclusion References CHAPTER 8: Vascular access Introduction Benefits Risks PERIPHERAL IV ACCESS Intraosseous Access Central intravenous access Special considerations Ultrasound‐guided IV access Conclusion References CHAPTER 9: Chest pain and acute coronary syndromes Introduction General approach Role of emergency medical dispatch The 12‐lead electrocardiogram Medications Prehospital fibrinolysis Systems of care for STEMI EMS transport Other common causes of chest discomfort Summary References CHAPTER 10: Cardiac dysrhythmias Introduction Evaluation Controversies Protocols Summary References CHAPTER 11: Cardiac procedures and managing technology Introduction Short‐term mechanical circulatory support devices Long‐term mechanical circulatory support devices Electrical cardiac support devices Pericardiocentesis Conclusion Acknowledgment References CHAPTER 12: Cardiac arrest systems of care Introduction Epidemiology of Cardiac Arrest Elements of a Community Cardiac Arrest Care System Role of the Medical Director Optimizing System Design Summary References CHAPTER 13: Cardiac arrest: clinical management Introduction Specific interventions Principles of management Post cardiac arrest care Summary References SECTION IV: Medical Problems CHAPTER 14: The challenge of the undifferentiated patient Introduction History Taking Physical Examination The truly Undifferentiated Patient Conclusion References CHAPTER 15: Altered mental status Introduction Assessing mental status Approach to the patient with AMS Presentations, etiologies, and treatments Conclusion References CHAPTER 16: Syncope Introduction Pathophysiology Assessment Differential diagnosis Treatment Disposition Summary References CHAPTER 17: Seizures Introduction Pathophysiology Differential diagnosis Classification of seizure types Symptomatic seizures Status epilepticus EMS evaluation and response Pharmacological interventions Seizure‐associated trauma Continuing management Refractory generalized convulsive status epilepticus Conclusion References CHAPTER 18: Stroke Introduction Emergency medical dispatch Prehospital care Definitive treatment options EMS transport Innovations in prehospital stroke management Disparities Summary Acknowledgments References CHAPTER 19: Abdominal pain Introduction Approach to the patient with abdominal pain Anatomy and physiology considerations History and physical examination Management Disposition Special populations Summary References CHAPTER 20: Diabetic emergencies Introduction Prehospital assessment Prehospital treatment Protocols Summary References CHAPTER 21: Allergic reactions Introduction Physiology of allergic reactions Causative agents Assessment and general approach Prehospital treatment Special considerations Conclusion References CHAPTER 22: Renal failure and dialysis Introduction A brief review Renal replacement therapy Renal transplant Complications of renal disease Complications of hemodialysis Complications of peritoneal dialysis Special considerations EMS pearls References CHAPTER 23: Infectious and communicable diseases Introduction EMS Clinician and Patient General Approach and Patient Assessment Specific Illnesses Biological Weapons Viral Hemorrhagic Fevers Conclusion References CHAPTER 24: Choking Introduction Pathophysiology and epidemiology Patient assessment Management Medical oversight considerations Controversies Summary References CHAPTER 25: Submersion injuries and drowning Introduction Epidemiology Pathophysiology of drowning Clinical management Grief reactions References SECTION V: Trauma Problems CHAPTER 26: Trauma systems of care Trauma system organization Trauma care facilities Communications Emergency response Medical oversight Data collection Emergency management Injury prevention Summary References CHAPTER 27: Blunt trauma considerations Introduction Effect on EMS Training for EMS clinicians Resuscitation and initial assessment Constellations of blunt traumatic injury Issues in specific patient populations Medical oversight issues in trauma Guidelines for out‐of‐hospital management Prevention and other public health issues References CHAPTER 28: Motor vehicle crashes Introduction Effect on EMS MVC injury biomechanics Safety restraints MVC types Crashes involving vulnerable road users EMS crash assessment priorities Unique MVC problems Emerging technology Available education References Chapter 29: Penetrating trauma Introduction Physics and mechanics of penetrating trauma Types of weapons High‐velocity projectile injury Resuscitation and initial assessment Transport issues Penetrating chest trauma Penetrating abdominal trauma Penetrating neck trauma Penetrating head and facial trauma Penetrating extremity trauma Prevention and public health issues Medicolegal issues Forensic issues Prehospital termination of resuscitation in penetrating trauma Summary References CHAPTER 30: Traumatic Brain Injury Introduction Primary assessment Secondary assessment Prehospital intubation Additional treatments Concussion and Sports‐Related Head Injuries Pediatrics Transportation and Destination Decisions Summary References CHAPTER 31: Electrical injuries Introduction Pathophysiology Evaluation and treatment Assessment and management Special circumstances Conclusion References CHAPTER 32: Blast injury Introduction Explosive devices Blast injury Prehospital resuscitation and treatment Medical oversight Improvised explosive devices and terrorist activity Community risk assessment Summary References CHAPTER 33: Thermal and chemical burns Introduction Pathophysiology Severity Depth Burn size Inhalation injury Specific training requirements Burn‐specific patient assessment and care Special considerations Guidelines for out‐of‐hospital management Prevention Conclusion References CHAPTER 34: Crush injury Definition and concepts Pathophysiology of crush injuries Management of crush injury Management of crush injury with suspected crush syndrome Transport destination considerations Conclusion Acknowledgment References CHAPTER 35: Hemorrhage control Introduction Assessment Diagnosis of hemorrhagic shock Treatment modalities Nonmedical personnel training Internal occlusion Advanced hemostatic agents Second generation: Combat Gauze Adjunctive therapy Prevention of hypothermia Transfusion Medications Antiplatelet and anticoagulation medications Summary References CHAPTER 36: Orthopedic injuries Introduction Anatomy, fractures, and dislocations Splinting Reductions with (and without) medications Special considerations: partial or complete amputations and neurovascular injuries Conclusion References CHAPTER 37: Ocular trauma Introduction Epidemiology Evaluation Specific eye injuries Summary References CHAPTER 38: Bites, stings, and envenomations Introduction Animal bites Animal‐specific concerns Transport Summary References CHAPTER 39: Field trauma triage Background History of the field triage decision schemes Accuracy of field triage Field triage decision scheme Pediatric concerns Conclusion References CHAPTER 40: Trauma‐stabilizing procedures Introduction Needle thoracostomy Tube and finger thoracostomy Pericardiocentesis Spinal motion restriction Application of cervical collar Application of a long spine board (backboard) Summary Acknowledgments References SECTION VI: Obstetrics and Gynecology Problems CHAPTER 41: Physiology of pregnancy Introduction General considerations Pregnancy Effects by System (Box 41.3) Summary References CHAPTER 42: Emergencies of pregnancy Introduction Evaluation and transport of the pregnant patient Miscarriage Ectopic pregnancy Placental abruption Placenta previa Hypertension during pregnancy Preeclampsia Eclampsia Conclusion Acknowledgment References CHAPTER 43: Normal childbirth Introduction Pregnancy Evaluation of the pregnant patient Labor and delivery Postdelivery: care of the neonate Challenges of prehospital deliveries Special considerations References CHAPTER 44: Childbirth emergencies General considerations and resource management Management of abnormal presentations Conclusion References CHAPTER 45: Perimortem cesarean section Background Potential benefits of perimortem C‐section Performance of perimortem C‐section in the field Indications for perimortem C‐section Education Procedure Ethical and legal considerations Conclusion References SECTION III: Toxicological Problems CHAPTER 46: Principles of toxicology Introduction Evaluation Toxidromes Treatment Special considerations Protocols Summary Acknowledgments References CHAPTER 47: Treatment and evaluation of specific toxins Introduction Specific agents Summary References SECTION VIII: Environmental Problems CHAPTER 48: Cold exposure illness and injury Introduction Accidental hypothermia Nonfreezing cold injuries of the foot Frostbite/Freezing Cold Injury Cold‐water immersion Conclusion References Additional References CHAPTER 49: Heat‐related illness Introduction Physiology of thermoregulation Pathophysiology Heat edema Heat syncope Heat tetany Heat cramps Heat exhaustion Heat stroke Cooling techniques Summary References CHAPTER 50: High‐altitude illnesses Introduction Physiology Acute mountain sickness High‐altitude cerebral edema High‐altitude pulmonary edema Portable hyperbaric chambers Considerations for the medical director Conclusion References CHAPTER 51: Effects of flight Introduction Aerodynamic forces Effects on humans Summary References CHAPTER 52: Diving injury Introduction Types of diving Overview of diving physics Diving injuries Conclusion Acknowledgment References SECTION IX: Special Populations CHAPTER 53: The special needs of children Epidemiology of prehospital pediatric care Evaluation of children References CHAPTER 54: Pediatric medical priorities Introduction Respiratory and airway problems Brief resolved unexplained events (BRUE) Seizures and seizure mimics Shock Cardiac arrest Medication dosing safety Summary References CHAPTER 55: Pediatric trauma priorities Introduction Anatomical/physiological considerations and resulting injury patterns Resuscitation and management priorities Summary References CHAPTER 56: Technology‐dependent children Introduction The caregiver as a resource and the emergency information sheet The technology Conclusion References CHAPTER 57: Approach to the geriatric patient Introduction Changes of normal aging Assessment of the geriatric patient Geriatric medical conditions Cardiac arrest Social emergencies Special considerations Nursing homes and assisted living facilities Public health Summary References SECTION X: Special Considerations Chapter 58: Behavioral health emergencies Introduction Evaluation of the problem Assessment and treatment The suicidal patient The agitated and violent patient Patient restraint Verbal de‐escalation Physical restraint Medication to treat agitation Benzodiazepines Butyrophenones Ketamine Excited delirium syndrome Other situations Controversies and common mistakes Summary Acknowledgment References CHAPTER 59: Bariatric patient challenges Introduction Airway Breathing Circulation Bariatric surgery Patient packaging and movement Summary References CHAPTER 60: Intimate partner violence Introduction Scope of the problem Risks and vulnerabilities Understanding IPV IPV as a health care issue EMS clinician safety Assessment and examination [R]espond Additional considerations for EMS personnel Summary Acknowledgment Recommended Resources: References CHAPTER 61: Sexual assault Background Transgender sexual assault Psychological care of the patient Physical care of the patient Culture and sexual assault Legal aspects Mandatory reporting Sexual assault nurse examiners and sexual assault response team programs Summary Acknowledgment References CHAPTER 62: Child maltreatment Introduction Role of the prehospital clinician Child maltreatment Medical conditions that may be confused with child abuse Sexual abuse Responding to intimate partner violence calls Medicolegal duties Summary References CHAPTER 63: Human Trafficking Introduction Definitions Myths The scope of the problem The traffickers and the victims Red flags and indicators Clinical practice: EMS patient evaluation and care System oversight/medical direction considerations Conclusion Acknowledgment References CHAPTER 64: Ethical challenges Introduction Refusal of treatment and transport Triage decisions Termination of resuscitation Confidentiality Truth‐telling and error disclosure Personal risk Training and research Treatment of minors Summary References CHAPTER 65: Death, dying, and end of life issues Introduction Ethical foundations of end of life care Background Culture, customs, and racial disparity Advance directives The Physician Orders for Life‐Sustaining Treatment Program (POLST) Do not resuscitate orders End of life resources and other considerations Care of the grieving survivors Considerations during a pandemic Summary Dedication References CHAPTER 66: Family and bystanders Introduction Family support in patient care Ethnicity and culture of EMS clinicians The future of EMS and the role of family Social isolation Bystanders Spontaneous volunteers and civilian‐led rescue Bystanders and physicians on the scene EMS and violent bystanders Summary References CHAPTER 67: Analgesia Introduction Oligoanalgesia Opioids Nitrous oxide Ketamine Nonsteroidal anti‐inflammatory drugs (NSAIDs) Acetaminophen Nonpharmacological interventions Assessment of pain Addressing common myths Summary References CHAPTER 68: Point‐of‐care testing in EMS Introduction Is POC right for EMS? Is this POC test right for my service? Specific POC tests for consideration in the EMS setting Unique aspects of POC testing in mobile integrated health/community paramedicine Conclusion References CHAPTER 69: Ultrasound applications in the prehospital setting Introduction Why Prehospital Ultrasound? Settings of Field Use Indications Disaster and Mass Casualty Triage Military Role of Non‐Physicians/EMS Training Tele‐ultrasound Feasibility of Ultrasound in the Field Future Directions References Appendix: Chapter Mapping to the 2019 Core Content of EMS Medicine Glossary Index

3  Volume II Title Page Copyright Page Contributors Foreword Preface References About the Companion Site SECTION I: Principles of Oversight and Design CHAPTER 70: Medical oversight of EMS systems Introduction The evolution of the subspecialty of EMS State requirements for EMS medical direction Barriers to effective medical oversight of EMS Indirect medical oversight Direct medical oversight Direct patient care in the field Conclusion Acknowledgment References CHAPTER 71: Principles of EMS system design Introduction System Design Goals Services Vehicles Equipment and Supplies Delivery Settings Provider Organization Considerations Deployment Planning Performance Standards and Assurances Acknowledgments References CHAPTER 72: Emergency care regionalization Regionalization A case example The emergency medical care system Historical background Categorization and designation Federal efforts: Public Law 101‐590 Simultaneous processing Outcomes Diversion and bypass Payer and funding issues Future directions Conclusion References CHAPTER 73: Telemedicine and emerging telecommunications Introduction EMS telemedicine applications Conclusion References CHAPTER 74: Interfacility transportation Introduction Level of care Clinical indications for interfacility transportation Hazards associated with interfacility transportation Medical oversight of interfacility transport Legal considerations in interfacility transportation EMTALA Summary Acknowledgments References CHAPTER 75: Air medical services Introduction Background: History to Current System Design, Growth, and Costs Clinical Efficacy, Appropriateness, and Outcomes Safety, Quality, and Standards Integration and Regulations Regulation Operations Summary References SECTION II: Human Resources CHAPTER 76: EMS personnel Introduction Scope of practice The interdependent relationship between education, certification, licensure, and credentialing Regulating health care professions Summary: the synergy of three layers of public protection Acknowledgments References CHAPTER 77: Protection of EMS personnel from occupationally acquired infections Introduction Standards, laws, and regulations Blood‐borne pathogens Human immunodeficiency virus Airborne, droplet, and contact transmission of infection Recommended immunizations Reporting an exposure Summary Acknowledgment References CHAPTER 78: Medical surveillance of emergency response personnel Regulatory framework Overview Initial employment exam Baseline exam Annual or periodic examination On‐scene medical monitoring Exposure‐specific examination Termination or exit exam Summary References CHAPTER 79: EMS clinician wellness Introduction References CHAPTER 80: Occupational Injury Prevention and Management Introduction Occupational fatalities Occupational injuries Injury prevention Comparing studies References CHAPTER 81: Prevention and intervention for psychologically stressful events Introduction Emergence of occupational behavioral health as a fire and EMS priority Occupational health approach; organizational systems perspective Help seeking predilections vs. help delivery systems Building an integrated system The final fundamental: personal wellness and fitness Summary References CHAPTER 82: EMS practitioner education Introduction Theories of adult learning Language of learning Continuing education in EMS Conclusion References SECTION III: Legal and Legislation CHAPTER 83: Legal issues Introduction The legal framework of the physician/EMT relationship Sources of authority Sources of accountability Areas of liability Liability System concerns Summary Acknowledgments References CHAPTER 84: Legislation, regulation, and ordinance Introduction and brief history The role of legislation, regulation, and ordinance The language and structure of legislation, regulation, and ordinance Authorities established by states and examples of state‐specific language Federal legislation, regulation and policy affecting EMS The future of EMS legislation, regulation, and ordinance Summary Acknowledgment References CHAPTER 85: Due Process Introduction Law in the federal system Due process of law An opportunity to present reasons why the proposed action should not be taken Life, liberty, or property Impartiality of tribunal Notice Time for hearing Standard of proof Right to counsel Summary Acknowledgments References CHAPTER 86: Risk management Introduction Components of prehospital risk management Future directions–prehospital medical error Summary References CHAPTER 87: Politics and advocacy for the EMS physician Introduction Case Studies What is Advocacy? A History of EMS Advocacy Political Action Committees Navigating the Politics of Medical Direction Philosophy, Perspective, and Bias Preparing Yourself Principles of Action Sustaining the Drive Summary Acknowledgment References SECTION IV: Dispatch and Communications CHAPTER 88: Dispatch Introduction Emergency medical dispatch Use of L&S Anatomy of an EMD program Quality improvement Summary References CHAPTER 89: Ambulance safety Introduction Contributing Factors Recommendations Conclusions Acknowledgments References CHAPTER 90: Communications Introduction The context of EMS information communications technology System readiness/access/demand management Field clinician interaction and collaboration with medical direction A further note on telehealth/telemedicine The evolution of current‐day information communication system infrastructure and technical components VHF radio systems Evolving system infrastructure and components Resources for communications planning References SECTION V: Finance and Public Interfaces CHAPTER 91: Principles of finance Managerial accounting Productivity analysis Applying theory to real‐world decisions Conclusion References CHAPTER 92: State EMS Offices Introduction System leadership, organization, regulation, and policy Resource management–financial Resource management–human resources Resource management–transportation Resource management–facility and specialty care regionalization Public access and communications Public information, education, and prevention Clinical care, integration of care, and medical oversight Information, evaluation, and research Large‐scale event preparedness and response Conclusion References CHAPTER 93: EMS–public health interface Introduction Understanding public health Surveillance and databases Cardiac arrest: a public health emergency Mass vaccinations and paramedics Conclusion Acknowledgments References CHAPTER 94: EMS physicians as public spokespersons Introduction Perspectives and Caveats About Public Speaking The Challenges of Bite‐Speak Press Conferences Ten Golden Rules for Public Speakingor Dealing with Media Summary Acknowledgments References SECTION VI: Extraordinary Circumstances CHAPTER 95: Incident command system and National Incident Management System ICS standardization Summary Acknowledgments References CHAPTER 96: Medical management of mass gatherings Introduction Mass gathering types, definitions, and goals Mass gathering risk management Mass gathering event planning and operations Mass gathering personnel needs Mass gathering event training and drills Converting into MCI operations and postevent review Conclusion Acknowledgment References Chapter 97: Disaster preparedness and management Introduction Federal Framework for Disaster Management Catastrophic Events Health and Medical Resources Allocation of Scarce Resources Provider Credentialing Issues References CHAPTER 98: The federal medical response to disasters Introduction Overview of federal medical response to disasters National Response Framework Organization Base document Annexes ESF‐8: Public Health and Medical Services Select response components of ESF‐8 Legal authorities Disclaimer and Acknowledgment References CHAPTER 99: Prehospital triage for mass casualties Introduction Primary Triage Systems Primary Triage Categories SALT Triage START Triage The Evidence Base for Primary Triage Triage Tags Secondary Triage Tertiary Triage Population‐Based Triage Conclusion References CHAPTER 100: Mass casualty management Philosophy Mitigation and preparedness Response Recovery Special considerations Summary References CHAPTER 101: Mass casualty evacuation and patient movement Introduction Estimate Regional transportation Planning Execution Summary References CHAPTER 102: Temporary treatment facilities Introduction Type of event Planning and design of temporary treatment facilities Staff support Other considerations Summary References SECTION VII: Special Hazards CHAPTER 103: Medical support for hazardous materials response Introduction Developing standard operating procedures Identifying potential threats Medical response planning Personal Protective Equipment Accompanying accessories and attachments Responding to hazardous materials Decontamination Chemical removal techniques Medical monitoring of response personnel Conclusion References CHAPTER 5: Chemical properties of hazardous materials Introduction Types of Contamination General categories of hazardous materials Basic properties of hazardous materials General chemical properties of hazardous materials Identifying basic properties of hazardous materials Conclusion References CHAPTER 105: Radiological and nuclear response Radiation: definition and effects Normal radiation environment Radiation threats Types of ionizing radiation What radiation does not do Resources for the responder Training How to protect yourself Dirty bombs, exposure burns, and ingestion injury Nuclear weapons Effect on medical care Summary References Additional resources CHAPTER 106: Weapons of mass destruction Introduction Unique aspects of WMD Special requirements for WMD response Conclusion References SECTION VIII: Special Environments CHAPTER 107: Tactical emergency medical support Introduction History of tactical teams and TEMS The TEMS environment and limitations of traditional EMS response Operational considerations for clinician and casualty Tactical medical clinicians Controversies in TEMS Summary Acknowledgment References CHAPTER 108: Technical rescue, confined space, and limited access situations Technical rescue Urban search and rescue Confined space medicine Rescuer safety Specific clinical problems Summary References CHAPTER 109: Wilderness EMS Introduction Current Operations and Epidemiology Standardization Scopes of Practice Medical Oversight Operations Communications Protocols WEMS‐Specific Extrication, Treatment, Transport Equipment Survival Skills and Capability for Autonomous Operation Challenges to WEMS Systems Summary Author Disclosures References CHAPTER 110: Mobile integrated health and community paramedicine Introduction Brief history to present day Personnel education Medical oversight Integration with health care systems Conclusion Acknowledgment References SECTION IX: Safety and Quality CHAPTER 111: Patient safety culture Introduction to patient safety How accidents happen Doing things right Patient safety in EMS Just culture and adverse event reporting Evaluating organizational safety culture Changing organizational culture Safety management systems in EMS Methods to improve patient safety in EMS The future of patient safety in EMS Conclusion References CHAPTER 112: The evolution of quality concepts and methods Introduction Origins of improvement science History of quality improvement in health care Frameworks for quality improvement History of quality improvement in EMS Conclusions References CHAPTER 113: Defining, measuring, and improving quality Introduction Vision: Defining Quality Strategy: Using the Science of Quality and Performance to Create Improvement Tactics: Reimagining the EMS Quality Improvement Program Summary References CHAPTER 114: Information systems Introduction Existing registries and health care databases EMS information system design EMS system types EMS operations from a data perspective Public safety answering point EMS systems for 2030: a look at the future EMS information system components Elements of successful information systems References SECTION X: Advancing Knowledge CHAPTER 115: EMS research basics Why prehospital research? Getting started Analytical designs Conclusion References CHAPTER 116: Informed consent in EMS research The development of uniform requirements for the protection of human subjects The role of the IRB Public perception of prehospital care Informed consent History of the EFIC for emergency research Exception from informed consent and WIC regulations Conclusion References Additional resource CHAPTER 117: Out‐of‐hospital cardiac arrest research Introduction Clinical research designs Consistent definitions and the denominator Population description Data collection and reporting Outcome Assessment Outcome sources Statistical analyses Ethics and consent Quality control and monitoring in clinical trials Conclusions Acknowledgment References CHAPTER 118: Trauma research methodology Prehospital trauma study types Design Issues in Prehospital Trauma Studies Other considerations for prehospital trauma research Data analysis and trauma severity scoring Military prehospital trauma research Acknowledgment References CHAPTER 119: Pediatric research methodology Introduction The Need for Pediatric Prehospital Care Research Status of Pediatric Prehospital Research Challenges Unique for Pediatric Prehospital Researchers Pediatric Prehospital Research Priorities Moving Forward: Challenges and Opportunities References CHAPTER 120: Cost analysis research Introduction State of cost analysis research in EMS Types of cost analyses Conducting a full economic evaluation Charges versus costs Perspective Framework for EMS costs Joint production Conclusion References CHAPTER 121: Statistical concepts for research in emergency medical services Introduction Classical hypothesis testing Type I error Type II error and power Power analysis and sample size determination Statistical tests Parametric tests Nonparametric tests Confidence intervals Multiple comparisons Interim data analyses Subgroup analysis Intention‐to‐treat analysis Multivariable analyses Clustering Missing data Using statistical consultants References Appendix: Chapter Mapping to the 2019 Core Content of EMS Medicine Glossary Index End User License Agreement