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Validation by the House of Medicine

The field of emergency medicine, its subspecialties, and the roles of the emergency physicians have changed rapidly over the last 40 years. One of the earliest areas of subspecialty diversification was emergency medical services (EMS). The subspecialty is now recognized by the1:

  • American Board of Medical Specialties (ABMS)
  • American Board of Emergency Medicine (ABEM)
  • American Osteopathic Board of Emergency Medicine (AOBEM-CAQ)

Transport medicine has been a common component of an emergency physician's practice for a half-century. Even without certification, emergency physicians have been performing these duties, since physician medical oversight, usually as an operational medical director (OMD), is a requirement for most EMS agencies. Much of this formalization is a validation of the defined field knowledge and recognition of the vast and encompassing duties and research within the field.

Medical care delivered outside of a hospital involves not only traditional prehospital care but also inter-facility transports. Inter-facility transports have grown in importance as regionalization of specialty care has evolved from tertiary care and trauma centers to encompass pediatric specialty centers, acute cardiac interventional centers, stroke centers, and so on. Further, as healthcare grows more complex and evolved, the need for coordinated transporting of patients from hospitals to rehabilitation centers, skilled nursing homes, home care, and the like is dynamically changing “out-of-hospital” care. Indeed, proper healthcare resource utilization, cost-appropriate care, and profitability require the effective and efficient movement of patients within the healthcare system.

Historical Perspective

Out-of-hospital transport services are areas of practice diversification that have a rich history for emergency physicians and provide substantial opportunities for emergency department (ED) groups and the physicians comprising them. The mid to late 1980s saw a tremendous growth in the number of transport programs, primarily in rotor wing aircraft (Figure 56-1).

Figure 56-1.

The Bell 407 from the Fairfax County Police Helicopter Unit is responsible for trauma medevacs in Virginia's largest and most populace county. It is an excellent aircraft for single-mission trauma programs and can access tight landing zones.

This growth was due to regional expansion of trauma center and tertiary care programs with corresponding funding mechanisms to offset their operating costs. There was a major emphasis on the care of the traumatized patient and other critically ill patient populations, including cardiac, neonatal, pediatric, and other intensive care unit patients. As more hospitals incorporated trauma and acute care, there was expansion of

  • Trauma systems infrastructure
  • Need for a rapid and reliable method of transport
  • Requirement for critical care capabilities during transport (in the aircraft)

Thus the medevac model from the Korean and Vietnam wars was adopted into civilian practice. Further, hospital-based medevac programs also included highly trained critical care crews capable of substantial interventions far beyond ...

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