Emergency Medical Services: Clinical Practice and Systems Oversight is firmly established as the standard reference text for the medical subspecialty of EMS. Within the following pages is the distillation of the clinical practice of EMS medicine. This text provides the updated (2019) core content of the specialty for the next generation of EMS leaders, and provides an ongoing reference for the practicing clinician. NAEMSP extends its heartfelt thanks and gratitude to the editors, David Cone, Jane Brice, Ted Delbridge, and Brent Myers, for their tireless work; and to the authors for their important contributions that have brought this important body of knowledge to a third edition.
Though in gestation for over three decades, the actual specialty of EMS medicine is still in its infancy. The success and the relevance of EMS medicine will succeed or fail by our stewardship in the coming years. The validation of a specialty solely by virtue of the hard‐won achievement of recognition by the house of medicine will not, by itself, lead to a general acknowledgement among our colleagues, communities, and local, state, and national leadership that EMS physicians are truly the leaders of this important facet of the health care system and, as such, possibly not realize that EMS is even part of the health care system! The inflection point may be seen when more communities become invested in seeing the outcomes and quality metrics of their EMS systems, and begin to require that medical oversight is provided by an EMS physician, in the same way that they would seek out qualified physicians for other aspects of their health care systems. We will know we are on track as medical directors evolve into chief medical officers, and more commonly become direct‐reports to mayors as opposed to dotted lines to middle management, expected to be in the C‐suite meetings on the same level as other chief executives. We have the responsibility to become more deeply invested in local, state, and national political advocacy to have a voice on issues that affect our practice, our personnel, and our communities. The natural evolution of our specialty that seems out of reach at this point can become a positive “disruptive” force for health care. Those of you who are reading this text are those who will be responsible for the advancement of our specialty.
The latest edition of the text will be published during an era that has seen the rise of a global pandemic, a true 100‐year event, the full scope and effects as yet unknown at the time of this writing. It is likely that there will be sustained changes in EMS as a result of the lessons learned. This third edition should serve as a solid foundation for what EMS is, and the principles within will provide guidance for what it can become. Although the post‐pandemic landscape remains unrevealed, what is known and what will unequivocally not change is the ethos of dedication, service, valor, and heroism demonstrated by EMS during this crisis.
Michael Levy, MD
President 2021 & 2022
National Association of EMS Physicians®
Preface
Since the earliest version of this textbook in 1989, the subspecialty of EMS medicine has evolved dramatically. In addition to increasing sophistication and application of expertise, EMS has developed to encompass a unique body of knowledge. Recognizing these features and an ongoing need to nurture the professionalism of those physicians who are and might become committed to EMS, the American Board of Medical Specialties recognized EMS as a subspecialty in 2010. The American Board of Emergency Medicine administered the first certification examination in 2013, and at this writing there are 880 ABEM‐certified EMS physicians, with substantially more emergency physicians certified in EMS than in any other emergency medicine sub‐specialty. The Accreditation Council for Graduate Medical Education has accredited 71 EMS fellowship programs as of this writing.
This third edition of Emergency Medical Services: Clinical Practice and Systems Oversight builds on the foundations of its predecessors: EMS Medical Directors Handbook (1989), Prehospital Systems and Medical Oversight (1994, 2002), and the first two editions of this book (2009 and 2015). As with the 2015 edition, this text is intended to be the primary textbook for EMS fellowship programs, structured around the 2019 version of the core content of EMS medicine [1], which forms the basis for the ABEM certification examination. The Appendix maps the current EMS fellowship core content to specific chapters for easy reference. Noting that the ABEM certification exam is written to help assure the qualifications of the minimally qualified EMS physician who has attained “proficiency in managing the breadth of clinical conditions and operational aspects encountered by EMS systems in non‐traditional healthcare settings [2]”, this text is written at the “essentials‐plus” level. The intent is to cover the essential material that the exam candidate needs to know, with additional detail in key areas.
We thank the dozens of authors who have generously donated their time and effort to this new edition, and the hundreds of authors and editors of the past editions, upon whose efforts this latest edition are built.
D Cone
J Brice
T Delbridge
B Myers
April 2021
References
1 1 Delbridge TR, Dyer S, Goodloe JM, et al. The 2019 core content of emergency medical services medicine. Prehosp Emerg Care. 2020; 24:32–45.
2 2 American Board of Emergency Medicine. Emergency medical services. Available at: https://www.abem.org/public/become‐certified/subspecialties/emergency‐medical‐services. Accessed February 22, 2021.
About the Companion Site
This series is accompanied by a companion website:
https://naemsp.org/career‐development/textbooks/textbook‐support‐3rd‐edition/
The website includes:
Videos
Note: The videos are clearly signposted throughout the book. Look out for
CHAPTER 1 History of emergency medical services
Jon R. Krohmer
Before 1966: Historical Perspectives
The true origins of the concept of prehospital emergency care may not be clear, but there is no doubt that this philosophy has existed for centuries. Early hunters and warriors provided care for the injured. Although the methods used to staunch bleeding, stabilize fractures, and provide nourishment were primitive, the need for treatment was undoubtedly recognized. The basic elements of prehistoric response to injury still guide contemporary emergency medical services (EMS) activities. Recognition of the need for action led to the development of medical and surgical emergency treatment techniques. These techniques in turn made way for systems of communication, treatment, and transport,
