Benitez Fernando L, Pepe Paul E
Department of Emergency Medicine, University of Texas Southwestern Medical Center, Dallas, Texas 75390-8579, USA.
Curr Opin Crit Care. 2002 Dec;8(6):551-8. doi: 10.1097/00075198-200212000-00012.
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.
在某种程度上，几十年来北美地区的医生一直参与紧急医疗服务（EMS）系统。多年来，不同专业的医生都参与了紧急医疗服务，他们偶尔会成为紧急医疗服务系统的全职或兼职员工，但更多时候是基于自愿或小规模合同形式参与。无论雇佣关系如何，现在大多数州和省份都通过法规要求每个紧急医疗服务系统，特别是那些提供高级生命支持（ALS）服务的系统，要有一名指定的紧急医疗服务医疗主任。然而，在美国和加拿大的大部分地区，这类医生通常通过担任行政医疗监督员、教育工作者、导师，甚至在某些情况下担任系统经理来监督紧急医疗服务系统。在许多欧洲国家，医生是大部分严重院前医疗紧急情况的主要护理提供者。相比之下，在北美地区，基础急救医疗技术员（EMT）和护理人员（经过专门培训的高级生命支持提供者）充当紧急医疗服务系统医疗主任的替代者。在这种护理系统中，这类医生替代者在没有现场医生在场的情况下提供几乎所有的院前医疗护理干预。然而，由于他们的医疗监督要求，根据法规，北美地区的医疗主任通常仍需对患者护理负责。因此，在美国和加拿大的许多地区，负责的医生也会定期响应紧急医疗服务现场。他们会在宣布或未宣布的情况下，独立或与紧急医疗服务人员一起前往现场。以这种身份，他们可以作为急救医疗技术员、护理人员以及患者本人的直接患者护理资源。然而，通过在独特的院外环境中成为紧急医疗服务团队的间歇性参与成员，这些现场医生可以帮助更好地审查所提供的护理，从而根据需要更有效地修改适用的协议和培训。从历史上看，这类做法不仅在改革传统协议方面帮助了许多紧急医疗服务系统，还通过帮助确立改进的医疗护理优先级，甚至影响患者护理的系统管理变革。此外，积极参与不仅有助于负责的紧急医疗服务医生识别人员技能和系统方法中的弱点，还提供了在医学和管理方面树立榜样的机会。
