One of the major implications of our study is that it underscores the importance of studying the effect of prehospital care on non-mortality outcomes, in particular, the relief of discomfort. In fact relief of discomfort was the outcome parameter EMS professionals identified as having the most potential impact for the majority of children and adults in the top quartile conditions. Although EMSOP investigators, consultants and national experts participating in EMSOP I support the concept of alleviating discomfort as an important prehospital intervention, it is not known to what extent this opinion exists among prehospital care providers or other stakeholders such as patients, professional associations representing health care providers, and state and federal agencies. It may be difficult for some to modify the current mission of prehospital care, "saving lives", into a new mission, "relieving discomfort". While understanding the tenacity of traditional thinking, we do not think the importance of relief of discomfort in the prehospital arena should be any less important than it is in other health care arenas. It is important to investigate stakeholder attitudes toward prehospital management of discomfort, and the concomitant possibility for impeding prehospital relief of discomfort research or the application of its findings.
Another implication of our research is the importance of obtaining both core and condition specific risk adjustment measures and outcome measures from sources outside of the control of prehospital care systems. Data must be shared by health care facilities that participate in prehospital care systems. Current concerns regarding patient confidentiality will no doubt provide some challenges to this sharing of data. Nonetheless, failure to share such data will preclude any meaningful prehospital care outcomes research.