Style Changes at Prehospital Emergency Care

As we launched Volume 27 of Prehospital Emergency Care last month, another major formatting change has taken place, with the implementation of a new article style. The typesetting is cleaner, more modern, and more efficient with its use of space. In addition to the new cover color scheme and both internal and external formats of the journal, readers may also have noted some manuscript style changes that took place over the past year.

First and perhaps most obvious, we have eliminated all post-nominal listings (degrees, titles, and credentials) from the authors’ names immediately following the title on the front page of each article. We did this for several reasons, mostly centering on authors listing more “credentials” than are truly warranted. Most journals follow the AMA Style Guide, which allows for terminal degrees and certain widely recognized non-degree medical credentials such as registered nurse (RN) and emergency medical technician (EMT). The 2007 change in the terminology for the four “levels” of EMS personnel in the United States, however, complicated matters, as listing “Paramedic” as a post-nominal (in place of the old EMT-P) just reads oddly. Furthermore, including the National Registry of EMTs in a post-nominal credential (e.g., NREMT for Nationally Registered EMT, or NRP for Nationally Registered Paramedic) does not pass muster, any more than it would for a physician to list “NBMEMD” to indicate certification by the National Board of Medical Examiners. Finally, the AMA Style Guide no longer includes listing fellowships in various organizations (e.g., Fellow of the Academy of Emergency Medical Services [FAEMS] and Fellow of the American Academy of Emergency Medicine [FAAEM]). In the end, the simplest solution seems to be to drop everything; one can argue that the reader should judge the research on its own merits, not the credentials of the authors.

We are also following an industry trend and dropping the use of the term “provider” to refer to an individual. An excellent article from the Western Journal of Emergency Medicine (WestJEM) very nicely summarizes the rationale for this change (1). As with the National Association of EMS Physicians (NAEMSP) textbook Emergency Medical Services: Clinical Practice and Systems Oversight, our preferred term is “clinician.” Other useful terms include practitioner, responder, and personnel, with the latter two terms being especially useful when the group being referred to includes members who are not EMS-certified. However, as noted in the WestJEM article, it is always preferable to use a clinician’s actual job title (paramedic, EMS physician, respiratory therapist).

A few other style points and terminology preferences that we hope readers note and incorporate into their manuscripts, all of which are in keeping with the styles used in the NAEMSP textbook, and in some cases described in that book’s glossary:

9-1-1 instead of 911, per National Emergency Number Association standards.

Air medical services rather than aeromedical (which typically refers to flight physiology).

Health care instead of healthcare, per the AMA Style Guide (unless mentioning an organization such as the Agency for Healthcare Research and Quality [AHRQ] that uses “Healthcare” in its name).

Medical oversight (including direct medical oversight and indirect medical oversight) in place of terms that use medical direction or medical command (unless codified in things like state regulations, as in Pennsylvania where the term “medical command” is used).

Prehospital and not pre-hospital, in keeping with the journal’s title.

Telecommunicator is preferred to dispatcher, as it better describes the wide range of communications activities (not just dispatching) that these personnel undertake.

In keeping with Spaite’s 1993 time/interval model of the EMS response, use the term “time” for the moment a specific event occurs (e.g., alarm time), and “interval” for the temporal distance between two times (e.g., response interval) (2).

In most cases, “sex” is the correct term, not “gender,” since most studies are simply looking at biological male/female (e.g., in reporting patient demographics).

Copy-editing points:

Capitals: In general, avoid capitalization. Ordinary nouns such as emergency department, fellow, and trauma center do not require capitalization. The words federal, state, county, city, town, etc. are not capitalized unless writing out the formal name of a jurisdiction, as in “Orange and Putman Counties”.

Commas: Use the “serial comma” or “Oxford comma” before the last item in a series. Example: Our units are staffed by paramedics, EMTs, and EMRs.

Favor simplicity. Select “use” instead of “utilize,” except in the case of health care utilization. Generally, “and” can replace “as well as”.

Patients, EMS personnel, and other persons are “who,” not “that” or “which”.

First person is fine: “We found that” seems less stuffy than “The authors found that,” and “Our study shows” is smoother than “The present study shows”.

General manuscript writing:

For any sort of research manuscript, please be sure that last sentence of the “Introduction” section is a clear, concise statement of the study question. Also be sure that the “Conclusions” section clearly and concisely answers this study question that you have set out. (For additional advice and information on crafting the “Methods” section of a manuscript, see an accompanying article by Crowe and Cash in this issue (3); we have similarly revised the information in our online instructions for authors).

Acronyms: Avoid creating novel acronyms. Only define an acronym if it will be used again multiple times. There is no need for an acronym that appears only once or twice.

Please use figures, tables, and graphs judiciously. A 2001 paper by Schriger and Cooper provides an excellent discussion of the appropriate use of graphics (4).

Singular/plural: Please pay close attention to matching singulars and plurals. Example:

Incorrect: Drivers involved in an ambulance crash are at increased risk for additional ambulance crashes in the future.

Correct: Drivers involved in ambulance crashes are at increased risk for additional ambulance crashes in the future.

Data are plural.

Many of these points may seem arbitrary and overly picky, and the editorial board firmly believes that the science being described in these pages is the overriding priority. However, the ability to clearly and precisely convey what can be very complex science to a broad and diverse readership relies on writing that is similarly clear and precise. The reader who is truly interested in “writing science” is referred to an excellent text by Alley (5).

David C. Cone
Editor-in-chief
University of Hawai‘i at Mānoa