Development and Deployment of a Pre-Planned Hospital Emergency Response Team (HERT) for EMS Augmentation: Case Report and Program Review

Abstract

With the establishment and growth of the Emergency Medical Services (EMS) subspecialty, significant attention has been focused on clinical activities performed by EMS physicians in the out-of-hospital environment. An EMS fellowship includes special operations education to develop preparedness for responding to field situations requiring physician expertise. With only a thousand Board Certified EMS physicians in North America, EMS physicians may not be available 24 h per day to respond to field emergencies. Non-EMS physicians with minimal experience in prehospital or austere care may be called upon to respond to complex prehospital emergencies requiring advanced skills. The Los Angeles County EMS Agency implemented a policy in 1992 to establish Hospital Emergency Response Teams (HERT) as a regional resource to provide time-critical, specialized prehospital services within an EMS system. Activation of the HERT is rare, most frequently prompted by need for field amputation to enable extrication. We describe one such incident of a field intervention by HERT and detail the staffing, training, and equipment considerations within our large regional EMS system.

Acknowledgments

The authors wish to thank the first responders, EMTs, paramedics and EMS physicians of Los Angeles County for their ongoing dedication to innovation and excellence in the care of the people of Los Angeles County.

Declaration of Generative AI in Scientific Writing

The authors did not use a generative artificial intelligence (AI) tool or service to assist with preparation or editing of this work. The author(s) take full responsibility for the content of this publication.

Disclosure Statement

The authors report there are no competing interests to declare.

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Funding

No funding was provided for this work