May/June 2014 Emergency Medical Services

Page 17

Emergency Medical Services: The Newest Board Certified Physician Subspecialty


n 2006 the Institute of Medicine’s Committee on the Future of Emergency Care in the U.S. published “Emergency Medical Services at the Crossroads.” This work provided a broad, indepth assessment of the state of readiness of our nation’s front line emergency care delivery system. This committee recommended standardizing the medical oversight of EMS and improving the scientific basis of prehospital medicine through the development of a subspecialty certification in EMS through the American Board of Emergency Medicine (ABEM).1 The National Association of EMS Physicians (NAEMSP) had been organizing EMS medical directors since its founding in 1984. Through its peer reviewed journal, Prehospital Emergency Care, NAEMSP had been building the evidence basis for prehospital medicine. Together with the American College of Emergency Physicians (ACEP), NAEMSP submitted an application for EMS subspecialty certification to the American Board of Medical Specialties (ABMS) in 2009. In 2010 all 24 member boards of ABMS unanimously approved EMS as the sixth board certified subspecialty offered through ABEM. In doing so they identified EMS as a clinical specialty focusing on the care of patients outside of traditional medical care facilities. “The purpose of subspecialty certification in EMS is to standardize physician training and qualifications for EMS practice, to improve patient safety and enhance the quality of emergency medical care provided to patients in the

By Aaron Burnett, M.D.


prehospital environment and to facilitate further integration of prehospital patient treatment into the continuum of patient care.”2 This recognition required the development of a formal curriculum for training EMS physicians and in 2012 the Core Content of EMS Medicine was published in Prehospital Emergency Care.3 This was followed by accreditation of EMS fellowships by the Accreditation Committee on Graduate Medical Education (ACGME) in 2013. Today, there are two ACGME accredited EMS fellowships in Minnesota, one at Regions Hospital in Saint Paul and the other at HCMC in Minneapolis. Minnesota is known for innovation in EMS and our state frequently leads the way in defining best practices in prehospital medicine. Part of this tradition is due to the many leaders in EMS who practice in Minnesota. Dr. G. Patrick Lilja, the EMS medical director at North Memorial for many years, literally wrote the chapter on prehospital medicine in Tintinalli’s Textbook of Emergency Medicine. Dr. Daniel

The Journal of the Twin Cities Medical Society

Hankins (Mayo EMS) has served two terms as the president of the Association of Air Medical Services while Dr. Keith Wesley (HealthEast EMS) has served as the state medical director for both Wisconsin and Minnesota. Dr. RJ Frascone (Regions Hospital EMS), a full professor at the University of Minnesota medical school, has helped develop the scientific foundation of prehospital medicine through clinical and translational research. New techniques and technologies in prehospital resuscitation are often first developed in the streets of our cities and the back of our ambulances. Dr. Brian Mahoney was a leader in defining the benefits which public access defibrillation brings to victims of cardiac arrest. An innovative, team-based approach to CPR, termed “pit crew CPR,” was developed by Dr. Charles Lick (Allina EMS) which has revolutionized the way in which cardiac arrest resuscitations are choreographed. The concept of active compression-decompression CPR with intrathoracic pressure regulation (ITPR) was pioneered here and was proven to double the rate of neurologically intact survival following out-of-hospital cardiac arrest.4 Our EMS physicians have helped define new pathologies such as excited delirium and are developing novel approaches to prehospital chemical restraint, pediatric analgesia and airway management. A new prehospital concept, the Community Paramedic, was developed here under the medical direction of Dr. Michael Wilcox. Citizens in Minnesota are served by EMS systems which have a high level of involvement by their physician medical (Continued on page 16)

May/June 2014