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Describe the challenges and opportunities for an integrated emergency care data system for the delivery and care of critical illness and injury.Standardized data comparable across geographies and settings of care has been a critical challenge for emergency care data systems. Emergency medical services (EMS), emergency department (ED), ICU and hospital care are integrated units of service in critical illness and injury care. The applicability of available evidence and outcome measures to these units of service needs to be determined. A recently developed fully integrated, emergency care data system for quality improvement of EMS service delivery and patient care has been linked to ED, ICU and in-hospital data systems for myocardial infarction, trauma and stroke. The data system also provides a platform for linking EMS with emergency physicians, other healthcare providers, and public health agencies responsible for planning, disease surveillance, and disaster preparedness.Given its time-sensitive nature, new data systems and analytic methods will be required to examine the impact of emergency care. The linkage of emergency care data systems to outcomes based systems could create an ideal environment to improve patient morbidity and mortality in critical illness and injury.