Physician Oversight of Air-Based EMS
The National Association of EMS Physicians (NAEMSP®) affirmed the core principles of EMS physician oversight in the position statement Physician Oversight of Emergency Medical Services (Citation1). That document described the core principles of physician oversight and further defined activities that constitute delivery of EMS. In a subsequent position statement, Physician Oversight of Specialized EMS, NAEMSP® provided further discussion, stating that delivery of EMS in [certain] environments often requires clinical and operational aptitudes that demand both specialized training and specialized oversight (Citation2). One such environment is delivery of EMS in the air-based EMS (AEMS) setting, including helicopter and fixed wing transport vehicles. Recognizing the importance of providing focused guidance on the topic of physician oversight of air-based EMS, NAEMSP®, the American College of Emergency Physicians (ACEP), and the Air Medical Physicians Association (AMPA) collaborated to write this document.
NAEMSP®, ACEP, and AMPA believe that:
Physician oversight is integral to AEMS programs
Physician oversight of AEMS programs should include all of the fundamental principles outlined in the NAEMSP position statements referenced above, as well as the principles discussed below
Physician competence and proficiency in the knowledge and skills specific to the AEMS environment is necessary for the effective performance of physician oversight of AEMS programs. This includes additional focused knowledge and skills based on the scope of care provided by the AEMS service, including specialty transport (e.g. neonatal, ECMO) as applicable
Physicians providing oversight of AEMS must demonstrate aptitudes in the following:
Knowledge and understanding of how the physical, physiologic, and emotional stressors within the transport environment (including altitude physiology) impact the patient, crew, and equipment
Expertise in favorably balancing the risks and costs associated with flight operations with direct patient benefit
Fundamental understanding of national and local governmental statutes and regulations regarding prehospital and interfacility transport (i.e. retrieval medicine)
Understanding of aircraft capabilities and weather minimums
Understanding of Federal Aviation Administration (or equivalent) rules and regulations
Knowledge of legal and ethical issues specific to the AEMS setting
Familiarity with international transport issues including transport brokering, if applicable
Familiarity with commercial airline medical rules and regulations, if applicable
Physicians performing oversight of air-based EMS should be granted the authority to:
Physicians performing oversight of air-based EMS should be empowered with the following responsibilities:
In collaboration with local EMS systems and referral centers, develop and promulgate criteria for appropriate local and regional utilization of AEMS and establish processes for periodic review of operations to ensure compliance with those utilization criteria.
NAEMSP provides further guidance on the topic of AEMS utilization in separate documents available through the association’s website (www.naemsp.org) and published in Prehospital Emergency Care
Provide input into an AEMS service’s aircraft selection and/or the design of the medical interior to ensure that quality clinical care can be delivered
Participate in the AEMS service’s risk management program
Integrate the AEMS service into the regional ground-based EMS and healthcare delivery systems during “normal” daily operations
Integrate AEMS into in local and regional EMS and healthcare system multiple casualty incident and disaster planning
Engage in professional development activities via participation in AEMS professional organizations, conducting AEMS-based research, and becoming involved in the local, state, and federal legislative processes that affect AEMS
References
- Physician oversight of emergency medical services. Prehosp Emerg Care. 2017;21(2):281–2.
- Physician oversight of specialized EMS. Prehosp Emerg Care. 2019;23(4):590–1.