EMS Physicians Making House Calls

Gerald Wydro, MD, Regional Medical Director Bucks County Emergency Health Service, and Alvin Wang, DO, FAEMS, Regional Medical Director Montgomery County EMS

Emergency Medical Services (EMS) came into its own over fifty years ago with the landmark report Accidental Death and Disability: The Neglected Disease of Modern Society1 demonstrating the need for organized systems of prehospital care. The document sparked the creation of prehospital / trauma systems of care to reduce morbidity and mortality in communities. Later, the EMS Systems Act of 19732 and the EMS Agenda for the Future3 created modern-day EMS systems, including physician medical direction and oversight. Today, EMS leverages cutting-edge equipment, evidence-based protocols, and specialized training to “bring the hospital to the patient”. EMS Physicians are a critical component of modern EMS to ensure well-designed, high-quality systems of care.

Physicians in the prehospital environment must have a unique fund of knowledge, combined with specialized experience, equipment, and training to function effectively. In 2010, the American Board of Emergency Medicine (ABEM) formally recognized this unique physician practice environment as a subspecialty worthy of board certification. Many EMS Physicians have risen through the ranks, often having served as EMTs or paramedics before medical school. This has allowed EMS systems to integrate medical directors who have “walked the walk” as EMS practitioners

Medical direction of EMS involves administrative responsibilities like credentialing, quality assurance, and training; however, there is an ever-increasing role for EMS Physicians to actively respond in the field4. EMS Physicians bring advanced diagnostic and therapeutic options to our patients. With cutting-edge equipment like ultrasound or specialized treatment options in airway management and advanced resuscitation, modern EMS Physicians bring substantial additional resources and clinical experience directly to patients.

Bucks and Montgomery Counties sponsor dedicated EMS Physician Response Teams. The physicians are dispatched via the 911 center, responding in specialty EMS Physician vehicles, bringing advanced equipment, medications, and training to the scene. Whether functioning as part of a routine EMS response, a complex industrial accident, or a mass-gathering event. While direct patient care in the field is an important role, EMS Physicians also provide unique situational awareness during more complex prehospital events. Complex extrications, mass casualty incidents (MCI), congregate / vulnerable patient environments, hazardous materials incidents, and tactical responses all present unique challenges. The ability to provide a specialized physician, leveraging advanced equipment and training while focusing on patient safety, is extremely valuable. Additionally, these EMS Physicians ensure the continued wellness and protection of numerous other public safety responders present at these complex incidents.

The EMS Physicians of the Bucks and Montgomery County Physician Response Teams augment the outstanding first responders who serve our communities each day, bringing advanced care and treatment into the field to serve patients and communities. Our EMS Physicians still make house calls.

References

1 Accidental Death and Disability: The Neglected Disease of Modern  Society. Washington (DC): National Academies Press (US); 1966.

2 JAMA. 1974:230(8):1139-1140. doi:10.1001/1ama.1974.03240080021019

3 EMS Agenda for the Future [electronic Resource]. U.S. Dept. of Transportation,  National Highway Traffic Safety Administration; 1996

4 Physician Oversight of Emergency Medical Services, NAEMSP Position  Statement. 2016 doi.org/10.1080/19003127.2016.1229827