Resident field response in an emergency medicine prehospital care rotation.

BACKGROUND

Emergency medical services (EMS) is an important component of emergency medicine residency curricula. For over 20 years, residents at a university-affiliated program have staffed a physician response vehicle and responded to selected calls in an urban EMS system with online faculty backup.

OBJECTIVES

To describe the prehospital educational experience and patient care provided through this unique program and to assess residents' perceptions.

METHODS

This was a three-year retrospective study of patient care records for all prehospital resident responses. Information obtained included complaint, disposition, procedures performed, and medications administered. The number of EMS radio consultations provided by residents during this rotation was also sought. We surveyed 43 current and recently graduated residents to assess their perceptions of this experience.

RESULTS

Residents treated 1,434 patients during 1,381 scene responses (16.7 field patient contacts per resident-year). Complaints included cardiac arrest (788, 55.0%) and neurologic (230, 16.0%), traumatic (194, 13.5%), respiratory (144, 10.0%), and other cardiac (40, 2.8%) emergencies. Most patients (1,022; 71.3%) were transported to the hospital, including 82 of 143 patients (57.3%) who initially refused EMS transport. Residents performed procedures on 546 responses (39.5%), including 123 successful intubations, 115 central lines, 43 peripheral (IV) lines, and 10 intraosseous lines. EMS radio consultation records were available for only the second half of the study period. Residents provided 11,583 consultations during this one-and-a-half-year period (264 radio consultations per resident-year). Of the 40 returned surveys (93.0%), autonomy (n = 21), medical decision making (n = 10), and management of high-acuity patients (n = 7) were the most important perceived benefits of this program.

CONCLUSION

Our prehospital training program incorporates emergency medicine residents as in-field physicians and allows hands-on opportunity to provide patient care for a variety of conditions in the EMS environment, as well as extensive experience in online medical direction. The trainees believed it had a strong positive impact on their acquisition of important emergency medicine abilities.