The discrepancy in number of fully trained personnel vs. volunteer personnel may be a contributing factor in the at times tense relationship between prehospital first response staff. It is essential in the successful transition between prehospital care and emergency room triage that emergency room staff not only accept the diagnostic and assessment information provided by first responders but also that they be willing to incorporate those first responders into the initial intake of the victim into the hospital setting (Tziotos, et al., 2006). Incorporating first responders into the first stages of emergency room care is essential in that first responders were actually at the site of the accident and as such have access to a great deal of first hand information which could potentially expedite the initial intake and assessment allowing for physicians to begin treatment (McDermott & Cordoner, 2008). Though it is not a great deal of time which could potentially be saved, even seconds in the event of a severe trauma can mean the difference between life and death.

Though the incorporation of first responders into intake is useful, a more cohesive and crossover approach to the concept of emergency medicine is also necessary. Emergency medical technicians should undergo a great deal of training under the supervision of fully qualified emergency room doctors and emergency surgeons. This training would be effective not only in better preparing said technicians for the performance of their duties but also better inform them on the specific workings of emergency rooms and their staff. One of the single biggest obstacles to the overall carrying out of emergency medical procedures is the fact that first responders and physicians do not work well together. As a rule, there is a disconnect between the two professions largely resulting from the educational gap present. However, it is important to remember that irrespective of such a gap, the first responders will be a victim's first and sometimes only chance at even surviving long enough to reach the emergency room.

In terms of realistic training protocols, it must be remembered that effectively in the immediacy of a traffic accident or other roadway emergency, first response emergency personnel are responsible for a number of extremely significant and potentially life changing decisions. First they must assess the nature of potential injuries as well as their severity. Then they must take action to remove the victims from the crash if they are able to do so without the assistance of additional specialized personnel and tools. Once the victims are clear of the debris injuries must be reassessed to determine not only the amount of medical attention immediately necessary, but also the most useful means of transporting the victim and even which hospital the victim should be taken to. These factors are critical to the overall outcome of the victim's prognosis. Physicians trusting first responders more completely will ultimately result in both more efficient emergency room procedure as well as more effective event site treatment.

There are additional obstacles to the successful study of post traffic accident prehospital care. There was previous to the year 2000 no standardized national method of emergency response medicine protocol (Boyle, Smith, & Archer, 2008). Meaning, that effectively each of the states was free to implement their own methods of responding to and resolving traffic accidents. While large urban areas were more or less uniform in the training and successful treatment and triage protocol as discussed earlier in more rural areas such amenities were not available. This discrepancy in access to adequate first response medical care resulted in a majority of traffic fatalities coming from rural regions. This disproportionate mortality rate indicates that more so than any other factor it is the access to fully trained and equipped first responders (McDonnell et al., 2009).

In order to address these discrepancies, a variety of studies have been conducted incorporating both patient data as well as interviews with relevant staff and personnel both within the hospital setting and interviews with first responders. It was observed that in the context of a nationwide framework the mortality rate within the rural communities decreased significantly (McDermott et al., 2005). This is further support for the fact that a standardized system of care helps to ensure that irrespective of the population density or indeed the affluence of a region, accident victims will have access to the same caliber of care. A standard which could be assessed and identified and implemented without needing to run multiple different studies for each different system. Finally,...

Though the gathering of quantitative data is extremely useful it is time consuming as well as requiring of many permissions which student researchers do not have access to. One interesting feature of this study though is that it will incorporate the methods of numerous other research projects on the same topic. Though it could be argued that utilizing parts of other studies would result necessarily in an informational overlap, this potential overlap would still be useful in that more than one reference study will be used to create an amalgam of literary sources and interview questions generating original data.
The most challenging aspect of this project will be the successful accumulation of a significant amount of interview information. It is essential for student researchers not only to gain access to health professionals but also gain access to a range of professions within emergency medicine and a variety of locations in order to effectively understand the real challenges still facing such professions across the country. Necessarily in emergency medicine, it is extremely difficult to predict when there will be adequate time to schedule an interview also it is extremely difficult to gain access to such professionals given the necessarily stringent confidentiality issues surrounding specifically their work. It will be important for reasearchers to coordinate with hospitals and ensure that any questions asked will not violate the multitude of legal restrictions governing the health care profession.

In an effort to ensure that the greatest amount of information is collected from the most varied resources, it may be necessary to either devote time during the research period to travelling between states or make the decision to conduct interviews either via phone or video conference. Though this is not an ideal situation by any means, it may allow for the researchers to acquire a much greater sample of participants without seriously interfering in their own work schedule or the work schedule of those they are seeking to interview. This potential complication is only one of the many issues which may arise resulting in the shifting of research objectives or methods. It will be important to first ensure that adequate access will be available to healthcare professionals. It is recommended that prior to the beginning of research, letters be sent out to a sample of national hospitals explaining the project as well as what involvement is requested to the administrators of said hospitals. It is also advisable to offer either full access to the completed research project or some other remuneration for cooperation. Though it poses an ethical quandary to a degree, offering an incentive for participation, given that such incentive would be offered the hospital and not the specific individuals to be interviewed it can be assumed that such an offer would not directly influence the manner in which an individual answered the interview questions.

Questions should address not only the experience of emergency health professionals' experience with first responders and the various protocols associated with the variation in quality of prehospital care, but also what possible adjustments they themselves would make should they be in a position to do so. Though undoubtedly emergency doctors, nurses, surgeons et al. are consulted and researched in terms of the development of new policy regarding their profession. It is unlikely that they find themselves working in a system which they presently find no fault with. This same tack should be taken with first responders. Areas of specific interest include not only policy changes but also the manner in which they find that overlap between first responders and hospital care workers aids patient outcome.

The most effective method of continuing the research already established is to combine interviews with a thorough literature review. In an effort to further the existing body of research it will be essential for the researchers to gain access to both first response staff as well as emergency staff within the hospital setting. Though it would be extremely useful to address patient data for understanding specifically the comprehensive nature of prehospitalization care in the context of traffic accidents it will be essential to view historic as well…