Physician Oversight of Air-Based Emergency Medical Services: A Joint Position Statement of NAEMSP, ACEP, and AMPA

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 (1). 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 (2). 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:

  • Perform and execute the core elements of physician oversight described in “Physician Oversight of Emergency Medical Services” and in “Physician Oversight of Specialized EMS” (1,2)

  • Select, verify competency, and locally credential the AEMS service’s clinical crewmembers

• 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