AAEM Emergency Medical Services Section Letter to Membership
EMERGENCY MEDICAL SERVICES SECTION
C. J. Winckler, MD LP FAAEM
The work of EMS will only multiply in the complexity of calls and forward-thinking health care missions in the coming years.”
A
s an EMS physician and EMS medical director the question I dread the most is, “What is an EMS medical director?” If I’m giving my elevator speech, it generally starts and ends like this, “I write medical protocols for EMS, fire, and police.” Since I am talking to my colleagues, I appreciate the opportunity to explain what we EMS physicians do and how the American Academy of Emergency Medicine now has an EMS Section to support the mission of EMS physician clinical leadership. Importantly, the clinical component of emergency medical services and the multiple non-traditional out of hospital patient care modalities deployed by EMS are ultimately the EMS physician’s responsibility. AAEM has consistently stated that every health care team must be led by a board-certified physician. The AAEM EMS Section supports the model relationship EMS physicians have with all levels of prehospital providers. This current model presents to the rest of health care the ideal that a physician led team in which every member is respected, valued, and heard. In this ideal model, physician medical directors routinely and regularly solicit information and recommendations from their non-physician colleagues, truly listen to them with the respect they deserve for the work they do and the expertise they have acquired, and formatively create policy and procedure based on this valuable input. All hospitals and clinical practices should look at how EMS functions and adjust their processes to reflect this respectful, successful practice which has proven to have maximum benefit for the patients it serves. The AAEM EMS Section will work to continue this successful model.
As EMS physicians, we are proud that the model of egalitarianism of the profession is how EMS medicine has always been practiced. It is organic for the physician’s involvement in EMS to include non-physician colleagues. Indeed, without emergency medical technicians, paramedics, and many of our other non-physician colleagues, the American EMS model would not work. Similarly, the emergency physician clinical leadership model of the emergency department would not work without the myriad non-physician medical colleagues serving patients in the hospital setting. With over 800 board-certified EMS physicians in the United States, emergency medical services is the largest sub-specialty of emergency medicine. Emergency medical services’ roots go back to the Napoleonic Wars, where triage was a term used to sort those that have a chance at survival, and where Dr. Dominique Jean Larrey innovated prehospital care by bringing ‘flying ambulances’ to the battlefield to better care for casualties near the point of injury. To this day the basic tenets of EMS are the same: deliver those that are sick or injured to an emergency department while providing life-saving interventions. While that tenet remains, the entire field has gone through much evolution over the last few decades. For physicians, the pioneering change was recognition of the practice of EMS physician as medical director in the form of a sub-specialty board certification from the American Board of Emergency Medicine. A recent example of this continued evolutionary progression is when the Health and Human Services Secretary made a historic announcement in a Washington, DC fire department station that a five-year pilot program, called “Emergency Triage, Treatment, and Transport (ET3),” would reimburse Medicare patient transport to destinations other than an emergency department. Previously, EMS would not be reimbursed for taking patients anywhere but a hospital. The ET3 pilot allows low risk patients to be transported directly to an urgent care center, clinic, or their physician’s office, and allows for an EMS clinician to be on scene with patient or via a telehealth platform and receive reimbursement for an evaluation. The ET3 concept, and similar programs in development, will require the EMS physician to be clinically responsible for another layer of clinical complexity in an already complex job. Over the last decade, EMS mobile integrated health (MIH) has moved a not insignificant portion of EMS providers away from the base operating model of “you call, we haul” to a patient centered, multi-provider approach that focuses more on public health and harm reduction than performing life-saving interventions. This author’s primary EMS agency offers an MIH-led acute care station in Texas’ largest homeless shelter
>> COMMON SENSE MARCH/APRIL 2022
51
