FOREWORD<br >The sight of an injured we)man lying in the middle of a busy<br >intersection in the heart of Manhattan on a snowy day in 1976<br >for fifteen minutes before the wail of an ambuhmce siren ap-<br >proached led an officer of the Macy Foundation to propose that<br >the Board of Directors initiate a progranl to improve emer-<br >gency medical services in New York City.<br > We are not a study-oriented tbundation; we prefer action<br >programs. We therefore concluded that aIT ot~jective investiga-<br >tion and evaluation conducted under the aegis of an important<br >academic department would stimulate action to upgrade pre-<br >hospital emergency care on a citywide basis. This assignment<br >was given to G. Thomas Shires， M.D.， Lewis Atterbury Stimson<br >Professor and Chairman of the Department of Surgery， Corncll<br >University Medical College.<br > A comparison of the data assembled by Dr. Shires and his<br >associates on the situation in New York City with that of sixleen<br >oflmr cities across the country produced a series of shock waves<br >that led the mayor of this city to institute major changes in<br >policy and practices.<br > As a resuh of that study the fimndation decided thal a<br >national perspective on EMS would be valuable， and a confer-<br >ence for that purpose was convened on 9 to 11 September 1979.<br > This report not only. contains contributions from physi-<br >cians active in the field in the United States， but reports from<br >Scandinavia and Japan on the status of EMS in those countries.<br > John Z. Bowers<br > President<br >6June 1980<br >