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). This document described the core principles of physician oversight and further defined activities that constitute delivery of EMS. The document states, “An entity that is involved with the response to provide medical care for ill and injured patients in the out of hospital setting constitutes an EMS service, regardless of whether patient transport is provided.” Furthermore, the document stipulates that “EMS medical directors must recognize the patient diversity and environmental hazards within their EMS service.”
In many circumstances, the environments and situations in which EMS providers operate may be hazardous and austere. Such environments include those under law enforcement control, within wilderness areas, inside confined spaces or collapsed structures, and within populated areas following natural or man-made disasters. These environments create challenges with access to the patient and egress from the environment. Resources for patient care may be limited by geographic barriers, structural instability, prolonged operational periods, or the presence of malicious human threats. Delivery of EMS in these environments often requires clinical and operational aptitudes that demand both specialized training and specialized oversight. Although each of these environments are distinct, collectively the delivery of out of hospital care in those settings is often referred to as “Specialized EMS.” Specific examples include, but are not limited to: tactical EMS, urban search and rescue (USAR), wilderness search and rescue, ski patrols, and dive rescue teams.
NAEMSP believes that:
Physician oversight is integral to specialized EMS programs
Physician oversight of specialized EMS programs should include all of the fundamental principles outlined in the aforereferenced parent NAEMSP position statement, as well as the principles discussed as follows
Physician competence and proficiency in the knowledge and skills specific to the specialized environment is necessary for the effective performance of physician oversight of specialized EMS programs
The EMS physician must understand the clinical effects of their specialized environment on the delivery of patient care
Physician oversight of specialized EMS should include interfacing and pre-planning with standard EMS programs active in the area of the specialized incident(s)
Specialized EMS protocols must be appropriate for the practice environment
Specialized EMS protocols must anticipate and be appropriate for prolonged operational periods
Specialized EMS protocols must be appropriate for the type of EMS providers delivering care in the specialized environment or incident
Specialized EMS can include assessment and intervention techniques and technology that are:
the same as standard EMS,
adapted from standard EMS but utilized in nontraditional manners; or
uniquely developed to meet the needs of specific environments
Protocols may include on-scene treatment and release of the patient without transport or additional medical evaluation/treatment (e.g., firefighter rehab, event/race medicine, etc., for certain conditions)
Physician oversight of specialized EMS programs includes anticipating education and training needs unique to the specialized environment and ensuring providers receive appropriate initial and continuing education to meet those needs
Specialized EMS should only be delivered by providers that have been appropriately trained to provide care in the specific environment
Last minute “expansion of scope of practice” of standard EMS providers and deploying them in an operational environment is not acceptable as it exposes those providers to unacceptable life-safety hazards, which risks causing harm to the provider, the patient, other providers, and the public
Specialized EMS may include care of animals such as canines and equines used in force protection, search and rescue, and extrication/extraction. EMS programs that utilize or are likely to encounter such animal team members should develop appropriate protocols to provide force protection and emergency care to such animals. Development of these protocols should occur with the support of a veterinarian familiar with such animals.