The purpose of this proposal is to improve public health through the creation of a large-scale network of prehospital and hospital care that will conduct pragmatic clinical trials addressing emergency medical conditions affecting brain, heart, lung and/or blood as well as life-threatening trauma.  The components of this proposal include King County Emergency Medical Services (KCEMS) in concert with the University of Washington and its Harborview and University Medical Centers.  This ? Hub?  will both participate in these clinical trials and provide administrative and academic oversight and leadership over additional community- based facilities in the Pacific Northwest, and an additional academic facility (the University of British Columbia in Vancouver, BC), which will serve as enrolling sites (or ? Spokes?)  for the conduct of these clinical trials.  This proposal strictly creates the network infrastructure for these anticipated trials, and not the trials themselves, which are as yet not known.  These trials, when forthcoming, will themselves require independent regulatory approval which is anticipated to occur through a Central Institutional Review Board that will be created once the network itself is established.