In the United States, over 15.9 million patients per year are transported to emergency departments (ED) by emergency medical services (EMS), and 40% of all hospital inpatient admissions arrive by ambulance.1 Physicians have dedicated a significant portion of their practice to EMS since the late 1960s. EMS physicians acquired their expertise primarily by direct experience and together built the subspecialty through professional association, collaborative research, and standards development. EMS medicine has many roots, with growth spurts largely coming out of casualty care during warfare. Modern EMS started in Great Britain and Los Angeles in the early 1960s, driven by cardiologists who wanted a way to resuscitate cardiac arrest patients in the field.2 In the late 1960s with Death and Disabilities white paper, EMS saw exponential growth at the hands of surgeons who wanted a rapid way to evacuate and treat trauma victims on the nation's highways similar to the care and resuscitation of trauma victims during the Vietnam War.3 The majority of these surgeons also worked and staffed the “accident units,” precoursers of today's ED. When emergency medicine became an organized specialty in the late 1970s, it was a natural transition for these “new kids on the block” to take an active role in EMS since the interface was far more than that for physicians from other specialties. The growth of EMS medicine actually parallels the growth of emergency medicine to a large degree.
Discuss education and training backgrounds of practicing EMS physicians.
Describe available EMS medical director training courses.
Describe formal EMS physician fellowship training.
Describe the current state of EMS board certification and qualifications for examination.
Describe scientific and educational conferences that provide EMS physicians with state-of-the-art EMS research and clinical practice CME.
Discuss additional areas of training useful to EMS physicians fulfilling specific operational roles.
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.