title: Evolution of the literature identifying physicians' roles in leadership, clinical development, and practice of the subspecialty of emergency medical services.
abstract: OBJECTIVE
  The 2007 Institute of Medicine report entitled Emergency Medical Services at the Crossroads identified a need for the establishment of physician subspecialty certification in emergency medical services (EMS). The purpose of this study was to identify and explore the evolution of publications that define the role of the physician in EMS systems in the United States.
  
  
  METHODS
  Three comprehensive searches were undertaken to identify articles that define the physician's role in the leadership, clinical development, and practice of EMS. Independent reviewers then evaluated these articles to further determine whether the articles identified the physician's role in EMS. Then, identified articles were classified by the type of publication in order to evaluate the transition from a non-peer reviewed to peer-reviewed literature base and an analysis was performed on the differences in the growth between these two groups. In addition, for the peer-reviewed articles, an analysis was performed to identify the proportion of articles that were quantitative versus qualitative in nature.
  
  
  RESULTS
  The comprehensive review identified 1,504 articles. Ninety articles were excluded due to lack of relevance to the US. The remaining 1,414 articles were reviewed, and 194 papers that address the physician's role within EMS systems were identified; 72 additional articles were identified by hand search of references for a total of 266 articles. The percentage of peer-reviewed articles has increased steadily over the past three decades. In addition, the percentage of quantitative articles increased from the first decade to the second and third decades.
  
  
  CONCLUSIONS
  This comprehensive review demonstrates that over the past 30 years an evidence base addressing the role of the physician in EMS has developed. This evidence base has steadily evolved to include a greater proportion of peer-reviewed, quantitative literature.
authors.affiliation: Department of Emergency Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland 21205, USA. millin@jhmi.edu
authors.forename: Michael G
authors.initials: MG
authors.lastname: Millin
authors.forename: Lawrence H
authors.initials: LH
authors.lastname: Brown
authors.forename: Catherine K
authors.initials: CK
authors.lastname: Craven
authors.forename: Seth C
authors.initials: SC
authors.lastname: Hawkins
authors.forename: David K
authors.initials: DK
authors.lastname: Tan
authors.forename: Gina M
authors.initials: GM
authors.lastname: Piazza
authors.forename: David C
authors.initials: DC
authors.lastname: Cone
authors.forename: Richard W
authors.initials: RW
authors.lastname: Sattin
mesh_terms: D004632:Emergency Medical Services / Q000458:organization & administration* / Q000639:trends*; D004635:Emergency Medicine / Q000458:organization & administration; D006801:Humans; D007857:Leadership; D017712:Peer Review, Research; D010506:Periodicals as Topic / Q000706:statistics & numerical data*; D010819:Physician's Role