Preface

The practice of EMS Medicine continues to evolve, bringing greater expectations of the physicians who provide field care and medical oversight. Physicians are integral components in the medical direction of ambulance agencies, fire departments, rescue squads, law enforcement organizations, and emergency management agencies. Physician field response is becoming a more regular component of modern EMS systems and EMS physicians are becoming more defined in their scope of practice. The breadth of knowledge and skills required to serve as a competent EMS physician is unique and rapidly expanding. The advent of board-certification, start of ACGME-accreditation of fellowship programs, and the continuous broadening of the clinical practice of EMS Medicine has made the formal study of the art and practice even more essential than ever before.

There have been many milestones along the road of the development of the specialty. In 1966 when the white paper entitled Accidental Death and Disability: The Neglected Disease of Modern Society was released there was little attention paid to the practice of emergency care in the prehospital arena or even within the hospital setting. Dr Zoll had performed the first successful defibrillation and Drs Elam and Safar had introduced cardiopulmonary resuscitation (CPR) almost a decade earlier and yet EMS had not yet even begun its “Renaissance.” Even after the passage of the Highway Safety Act in 1966 and the EMS Systems Act in 1973 the medical component of EMS systems was slow to develop. EMS physicians of today have many of their predecessors to thank for the development of the modern EMS system. Pioneers like Drs Frank Pantridge, Leonard Cobb, Eugene Nagal, William Grace, and J. Michael Criley laid the foundation. Organizations like the National Associate of EMS Physicians (NAEMSP), Society for Academic Emergency Medicine (SAEM), American College of Emergency Physicians (ACEP), American College of Surgeons (ACS), and the National Association of Emergency Medical Technicians (NAEMT) pushed for the development of the science, education, and medical practices that formed the basis for our understanding of EMS Medicine well into the 1990s. In the early 1990s, EMS physicians made their first attempt at gaining official recognition as a subspecialty. Meeting fierce opposition, and lacking clear evidence of their unique area of practice, the movement suffered a significant defeat in 1995 with the disbanding of the American Board of Emergency Medicine's (ABEM) task force.

As we moved forward out of the 20th century, the practice of evidence-based medicine and the advancement of prehospital clinical research began to strip away the dogma of the past and gave rise to the early beginnings of the “Renaissance” of EMS Medicine. In 2003, the Institute of Medicine again exposed some glaring inadequacies of our EMS systems and at the same time made a very clear statement about the need for EMS Medicine physician specialists stating: “Delivery of clinical care in the field is quite different from delivering care in the hospital or other medical facility, and the oversight of EMS is complex.” Armed with enhanced data and medical literature, along with new-found recognition and political support, EMS physicians were able to successfully petition the American Board of Medical Specialties (ABMS) and in September 2010 ABMS unanimously voted in favor of creating the subspecialty.

EMS Medicine has taken its place in the House of Medicine. Now it is our duty to ensure we show our worth and never-ending commitment to improving patient care across the entire scope of our practice as EMS physicians. Now is the time of our “Renaissance” and it is our most sincere hope that this text serves you well on your journey, wherever the practice of EMS Medicine may take you.

On behalf of the authors of this textbook,

Derek R. Cooney, MD, FF/NREMT-P, FACEP (Editor)