"Traumatic injuries result in more years of productive
life lost than any other disease and represent the
main cause of death among young people. Despite
the public health importance of trauma, there have been few
advances in early resuscitative care over the past several
decades. In this issue, Stiell and colleagues1 provide us with
an important investigation into the relation between advanced
prehospital care and outcomes from traumatic
injury.1 Stiell and colleagues used a before-and-after design
to document the change in survival with implementation of
an advanced life-support program. Their analysis is part of
the Ontario Prehospital Advanced Life Support (OPALS) project,
which has emerged as perhaps the most important and
comprehensive investigation into prehospital resuscitation
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