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the administration of emergency medical services (EMS) and the resuscitation from cardiopulmonary arrest have become almost completely encompassed within emergency medicine. Thus, emergency medicine has a unique perspective in medical care by dealing with time-sensitive and life-threatening disease processes across broad populations and geographies. The clinical practice of emergency medicine encompasses a wide variety of populations presenting with undifferentiated conditions and therefore providing distinct research opportunities. Evidence-based improvements in emergency care have been shown to improve immediate morbidity and mortality as well as affecting long-term outcomes. While there has been remarkable growth in the number of emergency care patients, emergency physicians, and emergency medicine training programs, there remain unique perspectives and challenges to emergency care that will require marked expansion of research endeavors. Future emergency care should be guided by evidence and based on high-quality research performed by well-trained investigators who have a realistic perspective on this challenge. Given the scope of emergency care, advances in emergency medicine research may be one of the most important areas of health care within the next decade. DEFINITION OF EMERGENCY CARE RESEARCH The broad scope of emergency care is reflected in the domains of emergency care research. The emergency care patient population is diverse and includes pediatric, geriatric, medically underserved, and minorities, as well as those with acute illness, exacerbation of chronic illnesses, and injuries (2). Correspondingly, emergency care research domains are broad in scope, covering broad ranges in the timing and scale of the entities being studied (Figure 1-1). Thus, emergency care research spans time-sensitive emergency care as well as chronic care, individual organ systems, regionalized health care systems, and population health. Three key aspects of emergency care research stand out (10): 1. Severity — life-threatening illness and injury 2. Vulnerability — all-inclusive populations, including geriatrics, pediatrics, and psychiatry 3. Time sensitivity — conditions marked in time-frames of minutes to hours Thus, emergency care research may be defined as “research [that] focuses on the discovery and application of time-critical diagnostics, decision making and treatments that save lives, prevent or reduce disability, and restore human health” (10). A global hypothesis for emergency care research is that “rapid diagnosis and early intervention in acute illness [and injury] or acutely decompensated chronic illness improves patient outcomes” (5). Consistent with this hypothesis, there are a number of emergency care interventions that have been shown to reduce mortality and improve outcomes for patients with acute, time-sensitive illness or injury (Table 1-1). CHAPTER 1 — WHAT IS ACUTE AND EMERGENCY CARE RESEARCH? 3 Examples of Emergency Care Research Domains Prevention and Chronic Care Acute Care Emergent Care Subcellular Cellular Organ Systems Human Models Syndromes and Presentations Injury Prevention Coronary Syndromes Emergent Infection Diseases (e.g. SARS, sepsis) Population Health Animal Models Disease Specific Healthcare Systems Scale Acute versus Chronic EMS Disease Managment Medical and Posttraumatic Resuscitation Research FIGURE 1-1. Examples of Emergency Care Research Domains (from the NIH Roundtable on Medical and Surgical Emergencies [2]) TABLE 1-1. Emergency Department Interventions that Reduce Mortality and Improve Outcomes 1. Timely administration of aspirin and fibrinolytic therapy for acute myocardial infarction 2. Percutaneous coronary intervention (PCI) within 90 minutes for ST-segment elevation myocardial infarction (STEMI) 3. Appropriate empiric antibiotic administration within 4–6 hours for pneumonia 4. Early goal-directed therapy (EGDT) for sepsis 5. Blood pressure management for both ischemic and hemorrhagic stroke 6. Therapeutic hypothermia for adults with ventricular fibrillation induced cardiac arrest 7. Administration of antibiotics for open fractures 8. Administration of antidotes, such as N-acetylcysteine for acetaminophen poisoning From NIH Roundtable on Medical and Surgical Emergencies (2). 4 CHAPTER 1 — WHAT IS ACUTE AND EMERGENCY CARE RESEARCH? IMPORTANT AREAS FOR EMERGENCY CARE RESEARCH A key characteristic of emergency care is the rapid assessment and treatment of potentially life-threatening illness and injury, often before a definitive diagnosis is possible. Thus, there is a need to rapidly characterize, or phenotype, emergency patients on the basis of the severity and acuity of their disease state (2, 8). Thus, an overarching priority in emergency care research is the development and testing of modalities and strategies for the efficient and rapid identification of serious injury and illness, often in a setting in which the clinical manifestations of the disease may be subtle or nonspecific; the disease prevalence is quite low, but the potential impact of a missed diagnosis or delay in definitive therapy is quite large (e.g., meningitis; myocardial ischemia). The development of such diagnostic strategies will require new and substantive 

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