Medical direction in emergency medical services: the role of the physician.
01 Feb 1987-Emergency Medicine Clinics of North America (Emerg Med Clin North Am)-Vol. 5, Iss: 1, pp 119-132
TL;DR: The history of EMS in this country is tracked and some suggested answers to the difficult questions facing this new specialty are provided.
About: This article is published in Emergency Medicine Clinics of North America.The article was published on 1987-02-01. It has received 25 citations till now. The article focuses on the topics: Specialty & Emergency medical services.
Citations
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TL;DR: The 1992 National Conference on CPR and ECC strongly endorses the position that all ECC systems assess their survival rates through an ongoing quality improvement process and that all members of the chain of providers should be represented in the outcome assessment team.
55 citations
TL;DR: Protocol deviations committed in prehospital care do not usually cause direct harm to patients, however, several disturbing trends were uncovered, including misconceptions in the use of IV therapy, a number of serious deviations in advanced cardiac life support protocols, and lack of communication with medical control.
39 citations
TL;DR: By becoming an intermittent participating member of the EMS team in the unique out-of-hospital setting, these on-scene physicians can help to better scrutinize the care rendered and thus more effectively modify applicable protocols and training as needed.
Abstract: To some extent or another, physicians have been involved in emergency medical services (EMS) systems in North America for decades. Over the years, physicians from different specialties have been involved with EMS, occasionally as full-time or part-time employees of the EMS system but more often on a voluntary or small contractual basis. Regardless of the employment relationship, most states and provinces now require by statute that each EMS system, particularly those providing advanced life support (ALS) services, have a designated EMS medical director. However, in the United States and most of Canada, such physicians typically oversee EMS systems by acting as administrative medical supervisors, educators, mentors, and, in some cases, even as system managers. Throughout many European countries, the physician is the primary care provider for a large percentage of the serious prehospital medical emergencies. In contrast, throughout North America, basic emergency medical technicians (EMTs) and paramedics (specially trained ALS providers) serve as the EMS system medical director's surrogates. In this system of care, such physician surrogates provide almost all of the prehospital medical care interventions without any on-scene physician presence. Nevertheless, because of their medical supervisory requirements, by statute, North American medical directors generally are still accountable for patient care. Therefore, in many areas of the United States and Canada, the responsible physicians also respond to EMS scenes on a routine basis. They do so, both announced and unannounced, independently or with EMS personnel. In this capacity, they can serve as a direct patient care resource for the EMTs, paramedics, and the patients themselves. However, by becoming an intermittent participating member of the EMS team in the unique out-of-hospital setting, these on-scene physicians can help to better scrutinize the care rendered and thus more effectively modify applicable protocols and training as needed. Historically, such practices have helped many EMS systems-not only in terms of reforming traditional protocols but also by helping to establish improved medical care priorities and even system management changes that affect patient care. In addition, active participation helps the accountable EMS physician not only to identify weaknesses in personnel skills and system approaches, but it also provides an opportunity for role modeling, both medically and managerially.
33 citations
TL;DR: There were significant differences in total prehospital care times and at-scene times between the control group and the two standing order groups and there are important implications to EMS systems that use extensive base hospital contact.
32 citations
TL;DR: It is clear that with properly adapted hardware and personnel trained to function in adverse environments while effectively delivering intensive care to a large number of patients with a variety of clinical syndromes, survival can be significantly increased for the most acutely ill.
30 citations
References
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TL;DR: Anyone, anywhere, can now initiate cardiac resuscitative procedures to give not only mouth-to-nose artificial respiration but also adequate cardiac massage without thoracotomy.
Abstract: Cardiac resuscitation after cardiac arrest or ventricular fibrillation has been limited by the need for open thoracotomy and direct cardiac massage. As a result of exhaustive animal experimentation a method of external transthoracic cardiac massage has been developed. Immediate resuscitative measures can now be initiated to give not only mouth-to-nose artificial respiration but also adequate cardiac massage without thoracotomy. The use of this technique on 20 patients has given an over-all permanent survival rate of 70%. Anyone, anywhere, can now initiate cardiac resuscitative procedures. All that is needed are two hands.
1,942 citations
TL;DR: It has been shown perhaps for the first time that the correction of cardiac arrest outside hospital is a practicable proposition and no death has occurred in transit in a fifteen-month period.
593 citations
TL;DR: Questions may be raised whether effective tidal exchange of air can be expected with the routine application of the currently taught chest-pressure arm-lift methods of resuscitation and whether the experiments upon which the recommendation was based take the behavior of the natural airway in the unconscious patient into consideration.
Abstract: QUESTIONS may be raised whether effective tidal exchange of air can be expected with the routine application of the currently taught chest-pressure arm-lift methods of resuscitation and whether the experiments upon which the recommendation of these methods were based take the behavior of the natural airway in the unconscious patient into consideration. Apparently, these methods were endorsed on the basis of comparative experiments in anesthetized and curarized adults, whose tracheas were intubated.1 , 2 Waters and Bennett,3 in 1936, and Nims and his associates,4 in 1951, were unable to provide adequate ventilation by these methods. We reinvestigated the problem and found that . . .
268 citations
TL;DR: A cardiopulmonary resuscitation message that can be given via telephone by emergency dispatchers directly to an individual reporting a cardiac arrest resulted in significantly better CPR performance than did impromptu instruction offered by professional disp atchers.
103 citations