CHAPTER 29: Roles and Responsibilities in the Field

INTRODUCTION

Traditional roles for the physician in EMS have involved quality improvement, protocol development, and provider education. In general, physicians do not typically provide routine EMS care in the field setting; however, the role of the EMS physician has been evolving. The National Association of EMS Physicians (NAEMSP) has issued a position statement affirming the role of EMS physicians in the field.¹ The role of the EMS physician is myriad and not well standardized as described in a 2000 field survey of the 125 largest cities in the United States.² Many EMS systems now provide mechanisms by which EMS-trained physicians can be called into the field to directly provide and/or coordinate patient care for unusual circumstances. These same EMS physicians can also provide real-time education, quality assurance, and online medical direction on routine calls.³ In addition, direct exposure to the challenging field environment can help the EMS physician with protocol development and provider education programs. In this chapter, we will provide an overview of the roles and responsibilities of EMS physicians in the field.

OBJECTIVES

• Describe the responsibilities of an EMS physician on the scene of a patient care call.

• Describe the some specific responsibilities of an EMS physician on the scene of an MCI (details covered in Chapter 75), the scene of a fire (details covered in Chapter 65), and on the scene of a tactical operation (details covered in Chapter 66).

• Discuss situations in which the EMS physician should act as a direct, on-scene, provider of patient care.

• Discuss how the EMS physician’s on-scene roles and responsibilities affect EMS provider education, CQI, and protocol development.

EMS PHYSICIAN ON THE SCENE

UNDERSTANDING THE CHALLENGES OF THE PREHOSPITAL ENVIRONMENT

Yet another benefit of EMS medical director field response is for the physician to gain a better understanding of the highly unique challenges of prehospital patient care. This level of understanding is crucial in protocol development, planning, and resource allocation. Although many EMS medical directors have had direct EMS experience as an EMS provider prior to becoming a physician, this is not universally the case. As EMS systems advance in complexity, the increased need for EMS medical directors has resulted in many non–EMS-trained physicians being asked to oversee EMS programs. This diversity of experience has proven to be a benefit to the science of EMS medical oversight as increased involvement also brings new energies and ideas to the table.

Moreover, each EMS system poses its own unique set of geographic, political, technical, and financial challenges. It is important for the EMS medical director to be intimately familiar with the challenges of the prehospital system that he or she is tasked to oversee. This degree of technical understanding is necessary to operate effectively as a medical director and can only be gained through the ...