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Physicians began to take more interest in paramedics from a research perspective as well.

By about 1990, the fluctuating trends began to diminish, being replaced by outcomes-based research.

This research then drove further evolution of the practice of both paramedics and the emergency physicians who oversaw their work, with changes to procedures and protocols occurring only after significant research demonstrated their need and effectiveness ( an example being ALS ).

Such changes affected everything from simple procedures, such as CPR, to changes in drug protocols.

As the profession grew, some paramedics went on to become not just research participants, but researchers in their own right, with their own projects and journal publications.