Introduction: The standard of care for the treatment of potential spine injuries by emergency personnel in the prehospital setting has evolved in recent years. Current practice, however, varies widely, and evidence supporting individual approaches is limited. It remains unclear how new treatment protocols have been applied and how the attitudes of frontline providers influence their care. Additional questions about identifying and preventing additional traumatic spinal cord injury require detailed data that have been rarely reported, partly due to prehospital data-quality challenges. This manuscript-style dissertation aims to describe and analyze patterns of care, attitudes of paramedics to spinal precautions, and the landscape of data quality assessment practices in paramedic research. Methods: Patterns of treatment over the period of protocol changes were investigated in a retrospective database review of electronic patient care reports from the Winnipeg Fire Paramedic Service (WFPS). Attitudes of frontline providers were assessed in a cross-sectional survey of paramedics in the WFPS. To describe the landscape of data quality assessment practices in paramedic research, a scoping review protocol was developed and then applied according to established standards. Results: The rate of treatment with spinal precautions has decreased significantly since 2009, with accompanying changes to several specific elements of care, such as patient positioning and choice of devices. Survey findings indicate that respondents feel that spinal precautions are seen as less important than in the past, that they are treating fewer patients than previously, and that they follow protocol in most situations. A review of data quality assessment practices analyzed 97 articles that met inclusion criteria. Included studies varied widely in many characteristics, but summary findings identify challenges and potential areas for progress in supporting data quality in paramedic research. Conclusions: This thesis illustrates changing patterns of care during the period of protocol revision, accompanied by complex and nuanced attitudes on the part of paramedics towards their practice. These findings update our understanding of how paramedics treat potential spine injuries in the prehospital setting. Additional findings establish the landscape of data quality assessment practices in paramedic research as a necessary precursor to continuing work to link prehospital and in-hospital records.