In 2003, the Institute of Medicine (IOM) convened the Committee on the Future of Emergency Care in the United States Health System “to examine the emergency care system in the U.S., to create a vision for the future of the system, and to make recommendations for helping the nation achieve that vision.” One volume of this IOM report focused exclusively on EMS.1 The IOM noted that: “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.” Furthermore, the IOM acknowledged that EMS physician involvement improves the quality of care delivered by EMS systems.
As defined by the IOM, EMS comprises the crucial, early phases of the continuum of emergency medical care for acutely ill and injured persons including (a) 9-1-1 access and dispatch, (b) field triage and initial stabilization, and (c) treatment and transport in specially equipped ambulances or helicopters to hospitals or between medical facilities.
The term EMS system describes the organizational structure that integrates all of the essential components of EMS care. In their practice, EMS physicians provide direct emergency medical care for patients and medical oversight of EMS systems. They practice in every state, in a variety of different venues including industry, academia, private, municipal, fire-based and hospital-based systems. All states have regulations governing the role and responsibility of EMS physicians. Many states require specific medical director training which is often based on the national medical director curriculum developed by the National Highway Traffic Safety Administration (NHTSA).4
EMS medical practice is unique due to its position early in the continuum of patient care, physical location outside of fixed medical facilities, and relatively higher acuity of the patient population compared to emergency medicine. The majority of the most severely ill and injured patients presenting to ED arrive via EMS. EMS physicians provide direct patient care and medical oversight in unique settings such as mass gatherings, firefighting operations, disaster scenes, hazardous materials incidents, tactical law enforcement missions, and air medical and critical care inter-facility transports. As part of their clinical practice, EMS physicians are responsible for medical oversight of the EMS team. This includes daily direct medical decision making, control of care provided by EMS personnel, developing treatment guidelines, and ensuring procedural competency training of EMS personnel. EMS physicians also lead quality management activities relating to medical care delivered by the entire EMS system.
EMS physicians have developed treatments and techniques in the EMS environment that allow for patient safety and ensure proper treatment affecting the patient's final outcome.5–9 Extensive peer-reviewed articles address the roles of EMS physicians in the science and practice of EMS.10–18 EMS physicians are uniquely trained and positioned to provide the clinical care and leadership to mold prehospital- and hospital-based care into regionalized systems of care. The unique expertise gained from EMS physician field practice and system oversight improves patient safety and clinical outcomes.5
For over four decades, steadily increasing numbers of physicians have defined their professional practice as caring for patients in the EMS environment. Emergency medicine physicians comprise the principal physician group that has driven the growth of EMS practice since 1984. Current estimates are roughly 75% of EMS physicians are emergency medicine trained, 23% Family Medicine trained, with the remaining 2% being pediatricians, surgeons, and obstetrics and gynecology physicians. EMS physicians are often leaders in their communities concerned with meeting the needs of the public and provision of quality EMS care. Most academic emergency medicine departments employ an EMS physician who supervises the exposure of residents to EMS and engages in research activities to expand the scientific body of knowledge of this practice. EMS physicians hold key positions in several federal government agencies involved in EMS issues. Complex and sophisticated medical procedures previously only performed in hospitals, or completely unavailable a few decades ago, are now routinely integrated in EMS due to EMS physicians.19–22
EMS physicians play many pivotal roles. They serve as providers, expert consultants, and educators. Many EMS physicians plan prevention efforts implemented through the EMS system, with goals directed at reducing the societal costs of injury and illness. They facilitate optimal care through education and continual oversight of providers. EMS physicians reduce variability in care, limit interventions that are of no benefit, and facilitate delivery of care that enhances patient safety and improves outcomes.23–27 As the EMS subspecialty matures, patient outcomes will be further improved with continued advancement of scientific knowledge and treatments adding further sophistication to this area of practice.