SECTION 1: EMS Physician Scope of Practice

EMS Medicine as a Subspecialty

INTRODUCTION

This book is dedicated to the premise that emergency medical services (EMS) represent a bona fide field of physician subspecialty, that certain knowledge and skills are required, and that there is broad interest in learning about these matters. This chapter describes the subspecialty and begins the process of providing clarity to the roles of an EMS physician and the practice of EMS.

OBJECTIVES

• Define the scope of EMS medicine.

• Contrast EMS medicine to the practice of emergency medicine.

• Define EMS physician.

• Describe the necessary skill sets of an EMS physician.

THE BASIS FOR A SUBSPECIALTY

Indeed, since the earliest developments of EMS there have been physicians who applied their expertise to the nuances of providing care to the ill and injured in the field. They came from diverse clinical backgrounds, but they shared perspectives that optimal care provided as soon as a life-threatening condition could be recognized provided opportunities for improved outcomes. Though they may not have thought of themselves as such, they were the pioneer EMS subspecialists.

The next chapter will provide a historical overview of EMS. Among the various milestones of EMS development, there was generally a physician using his clinical knowledge, understanding of pathophysiology, and patients' needs to prompt innovation and advances of all sorts. Some might be considered logistical, such as when Jean Dominique Larry, Napoleon's chief military physician, built “ambulance volantes” to evacuate wounded soldiers from the battlefield.¹ Others might be considered clinical advances, such as the development of cardiopulmonary resuscitation (CPR) or Dr Frank Pantrindge's delivery of life-saving defibrillatory shocks to patients not yet at a hospital.^2,3 Still, others advanced the concept of medical oversight, as were the lessons of Drs Cobb and Copass in Seattle. Collectively, these examples help reveal the breadth of knowledge and skill required among EMS subspecialists.

Nevertheless, for some time there was a considerable struggle to define the nature of the EMS subspecialty and designate it as such. Among the challenges was the necessary distillation of a multifaceted and blended discipline to reveal and capture its clinical essence, upon which various administrative and health care management roles may be layered. That culminated on September 23, 2010, when the American Board of Medical Specialties (ABMS) officially recognized EMS as a physician subspecialty as requested by the American Board of Emergency Medicine (ABEM). The journey to that point is revealing, and in some respects is not unlike the path to recognition of emergency medicine as a specialty with its own unique fund of knowledge and purview.

The often-cited 1966 paper Accidental Death and Disability: The Neglected Disease of Modern Society pointed out a number of shortcomings in the American health care system related to trauma and emergency care.⁴ John M Howard, MD, was an army surgeon ...