Hostname: page-component-745bb68f8f-f46jp Total loading time: 0 Render date: 2025-02-10T05:49:56.292Z Has data issue: false hasContentIssue false
  • English
  • Français

Evolution of the Literature Identifying Physicians' Roles in Leadership, Clinical Development, and Practice of the Subspecialty of Emergency Medical Services

Published online by Cambridge University Press:  25 March 2011

Michael G. Millin ,
Lawrence H. Brown ,
Catherine K. Craven ,
Seth C. Hawkins ,
David K. Tan ,
Gina M. Piazza ,
David C. Cone  and
Richard W. Sattin
Michael G. Millin*
Affiliation:
Department of Emergency Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland USA
Lawrence H. Brown
Affiliation:
Anton Breinl Centre for Public Health and Tropical Medicine, James Cook University, Townsville, Queensland Australia
Catherine K. Craven
Affiliation:
Welch Medical Library, Johns Hopkins University, Baltimore, Maryland USA
Seth C. Hawkins
Affiliation:
Emergency Medical Care Program, Department of Health Sciences, Western Carolina University, Cullowhee, North Carolina USA
David K. Tan
Affiliation:
Department of Emergency Medicine, Washington University School of Medicine, St. Louis, Missouri USA
Gina M. Piazza
Affiliation:
Department of Emergency Medicine, Medical College of Georgia, Augusta, Georgia USA
David C. Cone
Affiliation:
Department of Emergency Medicine, Yale University School of Medicine, New Haven, Connecticut USA
Richard W. Sattin
Affiliation:
Department of Emergency Medicine, Medical College of Georgia, Augusta, Georgia USA
*
Correspondence: Michael G. Millin, MD, MPH Department of Emergency MedicineJohns Hopkins University School of MedicineBaltimore, Maryland 21205 USA. E-mail: millin@jhmi.edu
Rights & Permissions [Opens in a new window]

Abstract

Purpose: The 2007 Institute of Medicine report entitled Emergency Medical Services at the Crossroads identified a need for the establishment of physician subspecialty certification in emergency medical services (EMS). The purpose of this study was to identify and explore the evolution of publications that define the role of the physician in EMS systems in the United States.

Methods: Three comprehensive searches were undertaken to identify articles that define the physician's role in the leadership, clinical development, and practice of EMS. Independent reviewers then evaluated these articles to further determine whether the articles identified the physician's role in EMS. Then, identified articles were classified by the type of publication in order to evaluate the transition from a non-peer reviewed to peer-reviewed literature base and an analysis was performed on the differences in the growth between these two groups. In addition, for the peer-reviewed articles, an analysis was performed to identify the proportion of articles that were quantitative versus qualitative in nature.

Results: The comprehensive review identified 1,504 articles. Ninety articles were excluded due to lack of relevance to the US. The remaining 1,414 articles were reviewed, and 194 papers that address the physician's role within EMS systems were identified; 72 additional articles were identified by hand search of references for a total of 266 articles. The percentage of peer-reviewed articles has increased steadily over the past three decades. In addition, the percentage of quantitative articles increased from the first decade to the second and third decades.

Conclusions: This comprehensive review demonstrates that over the past 30 years an evidence base addressing the role of the physician in EMS has developed. This evidence base has steadily evolved to include a greater proportion of peer-reviewed, quantitative literature.

Keywords

emergency medical servicesevidence basedphysician's rolespecialties
Type
Comprehensive Review
Information
Prehospital and Disaster Medicine , Volume 26 , Issue 1 , February 2011 , pp. 49 - 64
Copyright
Copyright Millin © World Association for Disaster and Emergency Medicine 2011

Introduction

In 2007, the Institute of Medicine report Emergency Medical Services at the Crossroads included a formal recommendation to establish physician subspecialty certification in Emergency Medical Services (EMS).1 This supported a similar call for subspecialization issued in the EMS Agenda for the Future 2 by the National Highway Traffic Safety Administration (NHTSA). To advance this process, in 2008, the National Association of EMS Physicians (NAEMSP) and the American College of Emergency Physicians (ACEP) supported a project to identify and quantify the scientific studies and publications that define the unique role of the physician in EMS.

The project was a component of an application submitted to the American Board of Medical Specialties (ABMS) to create a formal subspecialty certification in EMS. This application requires the demonstration of the scientific basis for the subspecialty.3 In addition to the ABMS requirement, identifying the nature of the science supporting the subspecialty of EMS lends credibility to the position that EMS medicine is a unique clinical entity requiring specialized expertise.

While there are many elements to the scientific basis of a medical specialty, it was the goal of this project to specifically examine the direct participation of physicians in the practice of EMS medicine. It was felt that this was important so as to determine the extent to which physicians have been directly involved with the growth and development of EMS. This article describes this project and reports its findings.

Methods

A comprehensive review based on literature identified through three expert searches executed by a professional clinical librarian was performed. The purpose of this review was to identify the literature that defines the physician's role in an EMS system.

Search Strategy

Standard keywords and keyword phrases used by EMS practitioners and researchers that represent primary EMS concepts were identified by surveying the study authors, a group composed of six emergency physicians, a paramedic, and a clinical librarian. All six of the physicians are actively involved in EMS medical direction and/or EMS research. In every case where an appropriate Medical Subject Heading (MeSH) term exists, the librarian then identified the formal MeSH controlled vocabulary terms used to index the literature representing each of these EMS concepts. Ultimately, a total of 27 search terms, including keywords and MeSH-controlled vocabulary terms were used to represent the conglomerate term “EMS” (Table 1). Within PubMed, these EMS keywords and MeSH terms were combined in three different search strategies to identify articles reporting the scientific evidence underpinning three aspects of the physician's role in EMS, specifically: (1) the physician as an EMS leader (Leader); (2) the physician's role in the clinical development of EMS (Clinical); and (3) the physician's role in the practice of EMS medicine (Practice) (Table 1). Although there was considerable overlap in the three search strategies, this approach was taken to ensure the broadest possible search covering all three of these aspects of the physician's role in EMS.

Table 1 Search strategies (EMS = emergency medical services)

The searches for Leader, Clinical, and Practice were performed on 14 June 2008, 27 August 2008, and 26 June 2008, respectively. All years in the PubMed database, up to the dates of the searches were included in the study.

Review Strategy

Two independent reviewers evaluated each citation in the three retrieved sets to identify and exclude any papers that actually did not address the role of the physician in the leadership, clinical development, and practice of EMS. Papers that were not relevant to the structure of EMS systems in the United States also were excluded, since EMS system design and the role of the physician within an EMS system may be different in the US compared with other countries. Any discrepancies between the two reviewers were resolved by the primary investigator.

After this initial screening, the references from the bibliographies of the articles retained were searched by hand by one investigator to identify additional papers that met the inclusion criteria. Potential articles were reviewed by a second investigator with discrepancies resolved by a third investigator.

Classification Strategy

All of the articles identified for inclusion were placed into one of three final data sets: (1) citations published in peer-reviewed journals; (2) citations published in non-peer-reviewed journals; and (3) professional society position statements or governmental reports. The determination that a journal was peer-reviewed or non-peer-reviewed was made by referring to Ulrich's Periodicals Directory.4 In cases for which it was not possible to determine if a journal was peer-reviewed or non-peer-reviewed using Ulrich, the publisher of the journal was contacted directly.

Subsequently, the three data sets were examined to determine changes in the amount of published articles within each set over time. Changes in the proportion of peer-reviewed verses non-peer reviewed articles were evaluated using the Chi-square test for linear-by-linear association, with articles analyzed in 10-year increments (1978–1987, 1988–1997, and 1998–2007). Since the review did not include the full year's worth of articles from 2008, that year was excluded from this analysis.

In regard to the peer-reviewed articles, an analysis was performed to identify the percentage of articles that were quantitative versus qualitative in nature. Articles were defined as quantitative if the authors used either descriptive or comparative statistical analysis in the paper. Articles were analyzed in 10-year increments (1978–1987, 1988–1997, and 1988–2007). As with the analysis on peer-reviewed versus non-peer-reviewed papers, articles from 2008 were not included in this analysis. Analysis to determine changes over time was done using Chi-square for linear-by-linear association.

Institutional Review

This study was determined by the Johns Hopkins University Institutional Review Board as not qualifying as human subjects research.

Results

The process of identifying and selecting articles for inclusion, from the initial search to the final three data sets, is diagrammed in Figure 1. A total of 1,504 articles were identified via the three independent searches: 1,006 articles in the Leader set; 444 articles in the Clinical set; and 54 articles in the Practice set. Ninety of these articles were excluded because the articles clearly pertained to international EMS systems and were not relevant to EMS systems within the US (e.g., “The emergency medical system in Japan” and “Profile of the prehospital system in Madagascar”). Of the remaining 1,414 citations, (950 Leader, 411 Clinical, 53 Practice), 1,220 subsequently were identified for exclusion, with 194 unique papers addressing the physician's role within an EMS system retained for the review. Using the technique to calculate concordance in review as described by Sackett et al,Reference Sackett, Haynes, Guyatt and Tugwell5 Kappa values for the inter-rater reliability for the three review subsets (Leader, Clinical, and Practice) were 0.240, 0.475, and 0.764, respectively. Hand searching the references of these 194 papers identified an additional 72 relevant articles, for a final data set of 266 unique papers.

Figure 1 Flow of articles from initial search to final data sets (EMS = emergency medical services)

In terms of the type of publication, 184 papers were published in peer-reviewed journalsReference Alicandro, Hollander, Henry, Sciammarella, Stapleton and Gentile6–Reference Poultan, Gutierrez and Schwabe189 (Appendix); 55 papers were published in non-peer-reviewed journals190–Reference Salomone244 (Table 2); and 27 were position statements or governmental reports2,245–270 (Table 3).

Table 2 Articles published in non-peer-reviewed journals

Table 3 Position statements/governmental reports

When evaluating the growth of published articles over time, the number of articles published in non-peer-reviewed journals and the number of position statements or governmental reports has remained relatively stable. The number of peer-reviewed publications, however, surged in the mid-1980s, and since, has remained relatively constant and greater than the number of articles published in non-peer reviewed journals (Figure 2). Furthermore, the proportion of articles published in peer-reviewed journals has been steadily increasing, from 72% for 1978–1987 to 77% for 1988–1997 and 80% for 1998–2007 (Table 4), although this does not achieve statistical significance (p = 0.271). In addition, the proportion of articles in the peer-reviewed set that are quantitative, increased from 31% for 1978–1987 to 51% for 1988–1997 and 36% for 1998–2007 (Table 5), although this increase also does not achieve statistical significance (p = 0.972).

Figure 2 Number of peer-reviewed, non-peer-reviewed, and position statements/governmental reports related to the physician's role in EMS, 1978 to 2008

Table 4 Growth of peer-reviewed articles compared to nonpeer reviewed articles

Table 5 Proportion of quantitative versus qualitative articles in the peer-reviewed set

Discussion

The purpose of this study was to categorize the literature that identifies the role of the physician in the subspecialty of EMS medicine. Emergency medical services systems have grown dramatically since the 1960s, and the field of EMS medicine has an expanding evidence base that guides direct patient care activities in the prehospital setting, as well as maximization of resource utilization through EMS system designs and operational methods. Although the evidence base for EMS medicine still is in its infancy, this scientific knowledge has been steadily increasing since the 1970s, with marked increases in clinical trials beginning in the 1990s.1

The modern specialty of EMS began after the publication in 1966 of Accidental Death and Disability: The Neglected Disease of Modern Society.271 This document identified the need for a new discipline in medicine that would address the care of sick and injured patients outside of the traditional hospital setting, and the efficient transportation of these patients to appropriate acute care centers. More recently, both the National EMS Agenda for the Future 2 and the Institute of Medicine Report on EMS1 have called for formal recognition of EMS as a physician subspecialty. While there is no clear definition on what defines a medical specialty, and no accepted number of published articles required to establish that a medical specialty has a unique scientific basis, the findings in this review demonstrate that, over the past 30 years, there has been a building and evolving scientific basis addressing the unique role of physicians in EMS medicine.

Although this study was not designed to draw exact scientific conclusions from the compiled manuscripts, it is evident that there are some common themes identified in these manuscripts. The aggregate review of these manuscripts demonstrates that physicians have had a positive effect on the quality of patient care delivered in the out-of-hospital environment and the development of the science of EMS. Physicians have been instrumental in pushing the boundaries of EMS as medical specialty, and therefore, the continuous improvement of patient care. The current data set, with increasing proportions of manuscripts that are quantitative/peer-reviewed articles, lends credence to the gross analysis that these manuscripts show that the drive for quality in EMS by physicians has largely been through the establishment of measurable standards and an increasing scientific basis. Therefore, the 266 papers identified through this review demonstrate that there is a unique and specific body of evidence addressing the role of physicians involved in EMS, and that this body of evidence has shown that physicians have had a positive effect on the growth of EMS.

Limitations

In an effort to focus specifically on articles that addressed the role of the physician in EMS, a search strategy was designed that would only capture articles that were catalogued with one of the following search terms: Director, Institutional Management Teams [MeSH], Physician's Role [MeSH], or Physician Executives [MeSH]. While this strategy may seem a bit narrow, it was intended that in an unbiased manner, articles be indentifed that specifically addressed the physician's role in EMS. Therefore, this data set did not capture certain relevant articles on the overall development of EMS as a clinical specialty of medicine. Importantly, the intent of this review was not to identify sentinel or important papers related to EMS, but rather, to identify articles specifically addressing the unique role of physicians in EMS medicine. Future research may be designed to identify those articles that are important to the overall growth of EMS.

This review is limited further by lack of agreement by study authors in what articles to include in the final data sets. While study authors largely agreed on which articles to include from the Practice set (Kappa statistic = 0.764), there was less agreement on articles to include from the Clinical set (Kappa statistic = 0.475), and even less agreement from the Leader set (Kappa statistic = 0.240). It is possible that the lack of agreement reflects some statistical error as the Leader set was the largest of the three sets, and the Practice set was the smallest of the three sets. However, it also is possible that this variance in agreement reflects the differences in the opinions of the study authors' interpretations of the physician's role in EMS based on the three sets. Study authors appear to agree on the physician's role with regards to the Practice of EMS medicine, and to some extent, on the physician's role in the clinical development of EMS medicine, yet they appear to disagree on the role of the physician as a Leader in EMS medicine. This variance in agreement may reflect that the unique clinical aspects of the practice of EMS medicine are well understood by the authors, but the physician's role as a leader is less well defined.

There likely are two reasons for the variance in study authors' agreement on what articles to include in the leader set. Both of these reasons speak to the variance in which EMS physicians are leaders in EMS. Emergency medical services physicians serve in many different capacities that range from pure clinical work providing patient care in the out-of-hospital environment, medical oversight of ancillary healthcare providers in fire/municipal/commercial EMS agencies, EMS system data analysis and research, and local/state/national EMS system development. Some EMS physicians serve in a capacity involving some or all of these roles. With the great variance in the ways that EMS physicians work, it is no wonder that there is variance in the interpretation of what articles to include in the leader set. In addition, there is variance even within the clinical aspects the physician's role in EMS. Depending on the local environment, the physician will have varying degrees of leadership responsibilities and authority. This variance also will lead to a variance in the interpretation of what articles to include in the leader set. Therefore, the variance in what articles to include in the leader set perhaps is not surprising given the vast array of EMS system designs in the US, and the accompanying variations in how physicians are incorporated into the administrative structures of those systems.

Lastly, the review was limited to articles relevant to US EMS systems. The purpose of this study was to identify the role of the physician within EMS systems in the US. To the knowledge of the authors, physician participation within EMS systems varies greatly across the world. Therefore, as this project was performed to identify the scientific nature of EMS medicine within the US, it was felt best to exclude articles that defined EMS medicine in other countries. While this technically limited the breadth of the data set, had articles from international EMS systems been included, the data set would have been confounded by the variance in the role of physicians in these systems. Further study into the role of physicians in EMS medicine outside of the US may be warranted.

Conclusions

This review demonstrates that over the past 30 years, there has been significant growth in the number of published articles identifying the unique role of the physician in EMS medicine, specifically with regards to roles in leadership, clinical development and practice. This growing body of evidence consistently is evolving to include increasing numbers of peer-reviewed/quantitative articles. Collectively, these articles lend credence to the scientific basis of the physician subspecialty of EMS medicine.

Appendix Articles published in peer-reviewed journals

Abbreviations:

EMS = emergency medical services

MeSH = Medical Subject Heading

Presentation

An abstract of this paper has been presented at the National Association of EMS Physicians 2009 annual meeting in Jacksonville, Florida.

Financial Support

The authors received no financial support in the development of this paper.

References

Committee on the Future of Emergency Care in the United States–Subcommittee on Prehospital Emergency Medical Services. Emergency Medical Services at the Crossroads. Washington, DC: Institute of Medicine of the National Academies; 2007.Google Scholar
National Association of EMS Physicians, National Association of State EMS Directors. Emergency Medical Services Agenda for the Future. Published December, 1996. Available at http://www.nhtsa.dot.gov/people/injury/ems/agenda/emsman.html. Accessed 12 December 2008.Google Scholar
American Board of Medical Specialties. ABMS Bylaws. Section 7.3 (b) (iii) (a). ABMS, Chicago, IL. 2006.Google Scholar
Ulrich's Periodical Directory. Available at http://www.ulrichweb.com/ulrichweb. Accessed 01 May 2009.Google Scholar
Sackett, DL, Haynes, RB, Guyatt, GH, Tugwell, P: Clinical Epidemiology: A Basic Science for Clinical Medicine. Boston: Little, Brown, and Co., 1991.Google Scholar
Alicandro, J, Hollander, JE, Henry, MC, Sciammarella, J, Stapleton, E, Gentile, D: Impact of interventions for patients refusing emergency medical services transport. Acad Emerg Med 1995; 2(6):480–485.CrossRefGoogle ScholarPubMed
Alonso-Serra, H, Blanton, D, O'Connor, RE: Physician medical direction in EMS. National Association of EMS Physicians. Prehosp Emerg Care 1998;2(2): 153–157.CrossRefGoogle ScholarPubMed
Applebaum, D: The impact of a physician-staffed mobile intensive care unit. Am J Emerg Med 1985; 3(1):15–18.CrossRefGoogle ScholarPubMed
Arntz, HR, Stern, R, Linderer, T, Schroder, R: Efficiency of a physician-operated mobile intensive care unit for prehospital thrombolysis in acute myocardial infarction. Am J Cardiol 1992; 70(4):417–420.CrossRefGoogle ScholarPubMed
Aufderheide, TP, Kereiakes, DJ, Weaver, WD, Gibler, WB, Simoons, ML: Planning, implementation, and process monitoring for prehospital 12-lead ECG diagnostic programs. Prehosp Disaster Med 1996; 11(3):162–171.Google Scholar
Augustine, JJ, McCabe, JB, Singer, JI. Physician at the scene of an emergency. South Med J 1985;78(9):1074–1077.CrossRefGoogle ScholarPubMed
Ayres, R: Current controversies in prehospital resuscitation of the terminally ill patient. Prehosp Disaster Med 1990; 5(1):49–57.CrossRefGoogle Scholar
Baker, WM, Simone, BM, Niemann, JT, Daly, A: Special event medical care: The 1984 Los Angeles Summer Olympics experience. Ann Emerg Med 1986; 15(2):185–190.CrossRefGoogle ScholarPubMed
Benitez, FL, Pepe, PE: Role of the physician in prehospital management of trauma: North American perspective. Curr Opin Crit Care 2002; 8(6):551–558.Google Scholar
Bissell, RA, Seaman, KG, Bass, RRet al: Change the scope of practice of paramedics? An EMS/public health policy perspective. Prehosp Emerg Care 1999; 3(2):140–149.CrossRefGoogle ScholarPubMed
Born, CT, Briggs, SM, Ciraulo, DLet al: Disasters and mass casualties: I. General principles of response and management. J Am Acad Orthop Surg 2007;15(7): 388–396.Google Scholar
Bowman, WD: Perspectives on being a wilderness physician: Is wilderness medicine more than a special body of knowledge? Wilderness Environ Med 2001; 12(3):165–167.CrossRefGoogle ScholarPubMed
Boyd, D, Mieik, S, Lambrow, C: Medical control and accountability of emergency medical services systems. Vehicular Technology 1979; 28(4):249–262.Google Scholar
Briese, GL: Reassessing training levels for prehospital EMS personnel. J Emerg Med 1983; 1(1):67–71.CrossRefGoogle ScholarPubMed
Burke, JB: Synergistic management: The task of the flight nurse. Aviat Space Environ Med 1983; 54(3):261–262.Google Scholar
Burstein, JL, Hollander, JE, Delagi, R, Gold, M, Henry, MC, Alicandro, JM: Refusal of out-of-hospital medical care: effect of medical-control physician assertiveness on transport rate. Acad Emerg Med 1998; 5(1):4–8.Google Scholar
Champion, HR, Sacco, WJ, Gainer, PS, Patow, SM: The effect of medical direction on trauma triage. J Trauma 1988; 28(2):235–239.CrossRefGoogle ScholarPubMed
Coimbra, R, Lee, J, Bansal, V, Hollingsworth-Fridlund, P: Recognizing/accepting futility: prehospital, emergency center, operating room, and intensive care unit. J Trauma Nurs 2007; 14(2):73–76.CrossRefGoogle ScholarPubMed
Cone, DC, Weir, SD, Bogucki, S. Convergent volunteerism. Ann Emerg Med 2003; 41(4):457–462.CrossRefGoogle ScholarPubMed
Cone, DC, Kim, DT, Davidson, SJ: Patient-initiated refusals of prehospital care: Ambulance call report documentation, patient outcome, and on-line medical command. Prehosp Disaster Med 1995; 10(1):3–9.Google Scholar
Cooper, MA, Ornato, JP: Involving and educating base station physicians in paramedic programs. Ann Emerg Med 1980; 9(10):524–526.CrossRefGoogle ScholarPubMed
Cooper, A, Barlow, B: The surgeon and emergency medical services for children. Pediatrics 1995; 96(1 Pt 2):184–188.CrossRefGoogle ScholarPubMed
Cowley, RA: Close encounters of the Cowley kind: an exclusive Journal interview with R Adams Cowley, MD, director of the Maryland Institute for Emergency Medical Services, State of Maryland. Md State Med J 1978; 27(6):35–49.Google Scholar
Crimmins, T: Communicating DNR orders to ambulance personnel. Minn Med 1991;74:33–35.Google ScholarPubMed
Custalow, CB, Armacost, M, Honigman, B: Unique curriculum for emergency medicine residents as medical directors for rural out-of-hospital agencies. Acad Emerg Med 2000; 7(6):674–678.Google Scholar
Davis, EA, Billitier, AJ: The utilization of quality assurance methods in emergency medical services. Prehosp Disaster Med 1993; 8(2):127–132.CrossRefGoogle ScholarPubMed
Delaune, EF III, Lucas, RH, Illig, P: In-flight medical events and aircraft diversions: one airline's experience. Aviat Space Environ Med 2003; 74(1):62–68.Google ScholarPubMed
Delbridge, TR, March, JA: Variability in out-of-hospital trauma care: so what? Ann Emerg Med 2007; 49(3):302–303.CrossRefGoogle ScholarPubMed
De Lorenzo, RA, Boyle, MF, Garrison, R: A proposed model for a residency experience in mass gathering medicine: the United States Air Show. Ann Emerg Med 1993;22(11):1711–1714.CrossRefGoogle ScholarPubMed
Dice, WH: The role of military emergency physicians in an assault operation in Panama. Ann Emerg Med 1991; 20(12):1336–1340.Google Scholar
Domeier, RM, Hill, JD, Simpson, RD: The development and evaluation of a paramedic-staffed mobile intensive care unit for inter-facility patient transport. Prehosp Disaster Med 1996; 11(1):37–43.CrossRefGoogle ScholarPubMed
Dove, DB, Del Guercio, LR, Stahl, WM, Star, LD, Abelson, LC: A metropolitan airport disaster plan--coordination of a multihospital response to provide on-site resuscitation and stabilization before evacuation. J Trauma 1982; 22(7):550–559.CrossRefGoogle ScholarPubMed
Dracup, K, Alonzo, AA, Atkins, JMet al: The physician's role in minimizing prehospital delay in patients at high risk for acute myocardial infarction: recommendations from the National Heart Attack Alert Program. Working Group on Educational Strategies To Prevent Prehospital Delay in Patients at High Risk for Acute Myocardial Infarction. Ann Intern Med 1997; 126(8):645–651.Google Scholar
Eastridge, BJ, Jenkins, D, Flaherty, S, Schiller, H, Holcomb, JB: Trauma system development in a theater of war: Experiences from Operation Iraqi Freedom and Operation Enduring Freedom. J Trauma 2006; 61(6):1366–1372.CrossRefGoogle Scholar
Eckstein, M: Out-of-hospital pediatric airway management. Ann Emerg Med 2004; 44(2):181–182.CrossRefGoogle ScholarPubMed
Edlich, RF, Wish, JR, Britt, LD: An overview of revolutionary advances in emergency medical care in the United States. J Long Term Eff Med Implants 2004; 14(5):375–400.Google Scholar
Edlich, RF, Wish, JR, Britt, LD, Long, WB: An organized approach to trauma care: Legacy of R Adams Cowley. J Long Term Eff Med Implants 2004; 14(6):481–511.CrossRefGoogle ScholarPubMed
Eliaiek, L, Norton, R, Carmona, R: Medical director for air medical transport programs. Prehosp Disaster Med 1995;10:283–284.CrossRefGoogle Scholar
Erder, MH, Davidson, SJ, Cheney, RA: On-line medical command in theory and practice. Ann Emerg Med 1989; 18(3):261–268.CrossRefGoogle ScholarPubMed
Falk, JL: Medical direction of emergency medical service systems: a full-time commitment whose time has come. Crit Care Med 1993;21(9):1259–1260.CrossRefGoogle ScholarPubMed
Feldstein, B: Disaster emergency medical services. Ann Emerg Med 1986;15(10): 1254.CrossRefGoogle ScholarPubMed
Fiser, DH: Emergency medical services for children and pediatric subspecialty practice: A call to action. Pediatrics 1995;96(1 Pt 2):188–190.Google Scholar
Fox, E, Siegler, M: Redefining the emergency physician's role in do-not-resuscitate decision-making. Am J Med 1992; 92(2):125–128.Google Scholar
Gausche-Hill, M, Johnson, RW, Warden, CR, Brennan, JA: The role of the emergency physician in emergency medical services for children. Ann Emerg Med 2003; 42(2):206–215.CrossRefGoogle ScholarPubMed
Grange, JT, Baumann, GW, Vaezazizi, R: On-site physicians reduce ambulance transports at mass gatherings. Prehosp Emerg Care 2003; 7(3):322–326.CrossRefGoogle ScholarPubMed
Hall, SA. Potential liabilities of medical directors for actions of EMTs. Prehosp Emerg Care 1998; 2(1):76–80.CrossRefGoogle ScholarPubMed
Haller, JA Jr: Emergency medical services for children: what is the pediatric surgeon's role? Pediatrics 1987; 79(4):576–581.Google Scholar
Hamman, BL, Cue, JI, Miller, FBet al: Helicopter transport of trauma victims: does a physician make a difference? J Trauma 1991; 31(4):490–494.CrossRefGoogle Scholar
Hatley, T, Ma, OJ, Weaver, N, Strong, D: Flight paramedic scope of practice: current level and breadth. J Emerg Med 1998; 16(5):731–735.CrossRefGoogle ScholarPubMed
Haynes, BE, Niemann, JT: Letting go: DNR orders in prehospital care. JAMA 1985; 254(4):532–533.CrossRefGoogle ScholarPubMed
Hitt, JM, Sanders, AB: Prehospital care telemetry—How essential? J Emerg Med 1984; 1(5):417–420.CrossRefGoogle ScholarPubMed
Hobgood, C, Bowen, JB, Brice, JH, Overby, B, Tamayo-Sarver, JH: Do EMS personnel identify, report, and disclose medical errors? Prehosp Emerg Care 2006; 10(1):21–27.Google Scholar
Holliman, CJ, Wuerz, RCVazquez-de, MG, Meador, SA: Comparison of interventions in prehospital care by standing orders versus interventions ordered by direct [on-line] medical command. Prehosp Disaster Med 1994; 9(4):202–209.Google Scholar
Holliman, CJ, Wuerz, RC, Meador, SA: Decrease in medical command errors with use of a “standing orders” protocol system. Am J Emerg Med 1994;12(3): 279–283.CrossRefGoogle ScholarPubMed
Holliman, CJ, Wuerz, RC, Meador, SA: Medical command errors in an urban advanced life support system. Ann Emerg Med 1992; 21(4):347–350.CrossRefGoogle Scholar
Holroyd, BR, Knopp, R, Kallsen, G: Medical control. Quality assurance in prehospital care. JAMA 1986; 256(8):1027–1031.Google Scholar
Hoyt, BT, Norton, RL: Online medical control and initial refusal of care: does it help to talk with the patient? Acad Emerg Med 2001; 8(7):725–730.CrossRefGoogle ScholarPubMed
Hurd, WW, Montminy, RJ, De Lorenzo, RA, Burd, LT, Goldman, BS, Loftus, TJ: Physician roles in aeromedical evacuation: current practices in USAF operations. Aviat Space Environ Med 2006; 77(6):631–638.Google ScholarPubMed
Iserson, KV, Rouse, F: Prehospital DNR orders. Hastings Cent Rep 1989; 19(6):17–19.Google Scholar
Jaslow, D: Disasters: Experience and planning. Eur J Emerg Med 2005; 12(6):263–264.Google Scholar
Jones, JH, Murphy, MP, Dickson, RL, Somerville, GG, Brizendine, EJ: Emergency physician-verified out-of-hospital intubation: miss rates by paramedics. Acad Emerg Med 2004; 11(6):707–709.Google Scholar
Jones, JS, Reese, K, Kenepp, G, Krohmer, J: Into the fray: integration of emergency medical services and special weapons and tactics (SWAT) teams. Prehosp Disaster Med 1996; 11(3):202–206.CrossRefGoogle ScholarPubMed
Kallsen, G, Merritt-Lindgren, M: An emergency medical services curriculum for emergency medicine residencies. Ann Emerg Med 1984; 13(10):912–915.CrossRefGoogle ScholarPubMed
Kaye, K, Frascone, RJ, Held, T: Prehospital rapid-sequence intubation: A pilot training program. Prehosp Emerg Care 2003; 7(2):235–240.Google Scholar
King, BR, King, TM, Foster, RL, McCans, KM: Pediatric and neonatal transport teams with and without a physician: a comparison of outcomes and interventions. Pediatr Emerg Care 2007; 23(2):77–82.CrossRefGoogle ScholarPubMed
Klein, KR, Spillane, LL, Chiumento, S, Schneider, SM: Effects of on-line medical control in the prehospital treatment of atraumatic illness. Prehosp Emerg Care 1997; 1(2):80–84.Google Scholar
Knapp, JF: A call to action: the Institute of Medicine report on emergency medical services for children. Pediatrics 1995;96(1 Pt 2):173–174.CrossRefGoogle Scholar
Knott, A: Emergency medical services in rural areas: The supporting role of state EMS agencies. J Rural Health 2003; 19(4):492–496.CrossRefGoogle ScholarPubMed
Krug, S, Kuppermann, N: Twenty years of emergency medical services for children: A cause for celebration and a call for action. Pediatrics 2005; 115(4):1089–1091.Google Scholar
Kulp, RC: Preparing pre-hospital medical coverage for a Papal visit. Emerg Health Serv Q 1980; 1(1):111–129.CrossRefGoogle ScholarPubMed
Lahaie, UD: Recruiting ambulance volunteers: Rural physicians can help. CMAJ 1991;145(9):1089–1090.Google ScholarPubMed
Larkin, M: New York physicians respond to the terror, tragedy, and trauma. Lancet 2001;358(9286):940.Google Scholar
Lavery, RF, Doran, J, Tortella, BJ: A survey of advanced life support practice in the United States. Prehosp Disaster Med 1992;7:144–149.Google Scholar
Lavery, RF, Adis, MD, Doran, JV, Corrice, MA, Tortella, BJ, Livingston, DH: Taking care of the “good guys:” A trauma center-based model of medical support for tactical law enforcement. J Trauma 2000; 48(1):125–129.CrossRefGoogle ScholarPubMed
Leaning, J. Physicians, triage, and nuclear war. Lancet 1988; 2(8605):269–270.CrossRefGoogle ScholarPubMed
Lyons, TJ, Connor, SB: Increased flight surgeon role in military aeromedical evacuation. Aviat Space Environ Med 1995; 66(10):927–929.Google Scholar
Lyznicki, J, Subbarao, I, Benjamin, GC, James, JJ: Developing a consensus framework for an effective and efficient disaster response health system: A national call to action. Disaster Med Public Health Prep 2007;1(1 Suppl):S51–S54.CrossRefGoogle ScholarPubMed
Ma, OJ, Millward, L, Schwab, RA: EMS medical coverage at PGA tour events. Prehosp Emerg Care 2002; 6(1):11–14.Google Scholar
MacDonald, RD, Farquhar, S: Transfer of intra-aortic balloon pump-dependent patients by paramedics. Prehosp Emerg Care 2005; 9(4):449–453.CrossRefGoogle ScholarPubMed
Maio, RF, Bronken, T: Quality assurance in emergency medical service systems in Michigan: report of a survey. QRB Qual Rev Bull 1991; 17(12):392–395.CrossRefGoogle ScholarPubMed
Markenson, D, Dimaggio, C, Redlener, I: Preparing health professions students for terrorism, disaster, and public health emergencies: core competencies. Acad Med 2005; 80(6):517–526.CrossRefGoogle Scholar
Martchenke, J, Rusteen, J, Pointer, JE: Prehospital communications during the Loma Prieta earthquake. Prehosp Disaster Med 1995; 10(4):225–231.CrossRefGoogle ScholarPubMed
Martinez, C, Gonzalez, D: The World Trade Center attack. Doctors in the fire and police services. Crit Care 2001; 5(6):304–306.CrossRefGoogle ScholarPubMed
Martinez, R: New vision for the role of emergency medical services. Ann Emerg Med 1998; 32(5):594–599.Google Scholar
Matera, P: Medical direction of prehospital care. Ann Emerg Med 1994;24(6): 1200.Google ScholarPubMed
McArdle, A, Rasumoff, D, Kolman, J: Integration of emergency medical services and special weapons and tactics (SWAT) teams: The emergence of the tactically trained medic. Prehosp Disaster Med 1992;7:285–287.Google Scholar
McDonald, EM, MacKenzie, EJ, Teitelbaum, SD, Carlini, AR, Teter, H Jr, Valenziano, CP: Injury prevention activities in U.S. trauma centres: Are we doing enough? Injury 2007; 38(5):538–547.Google Scholar
McDonald, CC, Koenigsberg, MD, Ward, S: Medical control of mass gatherings: Can paramedics perform without physicians on-site? Prehosp Disaster Med 1993; 8(4):327–331.Google Scholar
McEvoy, MT: EMS and emergency physicians Ann Emerg Med 1997;29(2):301.Google ScholarPubMed
McFee, RB: Preparing for an era of weapons of mass destruction (WMD). Are we there yet? Why we should all be concerned. Part 1. Vet Hum Toxicol 2002; 44(4):193–199.Google ScholarPubMed
McSwain, NE Jr, Rodriguez, C: Disaster medical care: Mardi Gras. J Trauma 1982; 22(3):235–237.CrossRefGoogle ScholarPubMed
McKenas, DK. The evolving role of corporate medical departments in commercial aviation. Occup Med 2002; 17(2):169–78, iii.Google ScholarPubMed
McSwain, NE Jr: Medical control of prehospital care. J Trauma 1984;24:172.CrossRefGoogle Scholar
McSwain, NE Jr.: Medical control—What is it? JACEP 1978; 7(3):114–116.Google Scholar
McSwain, NE Jr.: Prehospital care from Napoleon to Mars: The surgeon's role. J Am Coll Surg 2005; 200(4):487–504.Google Scholar
Mechem, CC, Kreshak, AA, Barger, J, Shofer, FS: The short-term outcome of hypoglycemic diabetic patients who refuse ambulance transport after out-of-hospital therapy. Acad Emerg Med 1998; 5(8):768–772.CrossRefGoogle ScholarPubMed
Moody-Williams, JD, Krug, S, O'Connor, R, Shook, JE, Athey, JL, Holleran, RS: Practice guidelines and performance measures in emergency medical services for children. Ann Emerg Med 2002; 39(4):404–412.CrossRefGoogle ScholarPubMed
Morgan, DL, Trail, WR, Trompler, VA: Liability immunity as a legal defense for recent emergency medical services system litigation. Prehosp Disaster Med 1995; 10(2):82–90.Google Scholar
Morhaim, DK: Prehospital care: Emergency medical services. Am Fam Physician 1986; 33(2):263–270.Google ScholarPubMed
Mucha, P Jr: Trauma prophylaxis: Every physician's responsibility. Mayo Clin Proc 1986; 61(5):388–391.Google Scholar
Nelson, PH: You're the flight surgeon. Mishaps and fatalities. Aviat Space Environ Med 2004;75(12):1092–1094.Google ScholarPubMed
Norton, R, Heiser, J, Neely, K, Acker, A, Hedges, J: On-scene time for patients initially refusing treatment or transport. Prehosp Disaster Med 1991;6:293–297.Google Scholar
O'Connor, RE, Megargel, RE: The effect of a quality improvement feedback loop on paramedic skills, charting, and behavior. Prehosp Disaster Med 1994; 9(1):35–38.CrossRefGoogle ScholarPubMed
Palafox, J, Pointer, JE, Martchenke, J: The 1989 Loma Prieta earthquake: Issues in medical control Prehosp Disaster Med 1988;8:291.Google Scholar
Parrillo, SJ: Medical care at mass gatherings: Considerations for physician involvement. Prehosp Disaster Med 1995; 10(4):273–275.Google Scholar
Patterson, PD, Moore, CG, Brice, JH, Baxley, EG: Use of ED diagnosis to determine medical necessity of EMS transports. Prehosp Emerg Care 2006; 10(4):488–493.CrossRefGoogle ScholarPubMed
Peckinpaugh, K, Izsak, E, Lindstrom, D, Orlow, G, Couture, T, Rice, M: The advanced pedi-bag program: a hospital-EMS partnership to implement prehospital training, equipment, and protocols. Pediatr Emerg Care 2000; 16(6):409–412.Google Scholar
Pepe, PE, Mattox, KL, Duke, JH, Fisher, PB, Prentice, FD: Effect of full-time, specialized physician supervision on the success of a large, urban emergency medical services system. Crit Care Med 1993;21(9):1279–1286.CrossRefGoogle ScholarPubMed
Pepe, PE: Emergency medical services. Acad Emerg Med 1994; 1(2):131–133.Google Scholar
Pepe, PE: Impact of intense physician supervision on effectiveness of an EMS system. Ann Emerg Med 1988;17(7):752.(Abstract).Google Scholar
Pepe, PE: Out-of-hospital resuscitation research: rationale and strategies for controlled clinical trials. Ann Emerg Med 1993; 22(1):17–23.Google Scholar
Pepe, PE, Stewart, RD: Role of the physician in the prehospital setting. Ann Emerg Med 1986;15(12):1480–1483.Google Scholar
Pesik, N, Keim, ME, Iserson, KV: Terrorism and the ethics of emergency medical care. Ann Emerg Med 2001; 37(6):642–646.CrossRefGoogle ScholarPubMed
Peterson, TD: Commentary: medical direction for out-of-hospital emergency medical services. Ann Emerg Med 2002; 39(4):451–452.Google Scholar
Peterson, TD, Tilman, JB, Runge, JW, Hunt, RC: Motor vehicle safety: current concepts and challenges for emergency physicians. Ann Emerg Med 1999; 34(3):384–393.CrossRefGoogle ScholarPubMed
Pierson, K, Power, Y, Marcus, A, Dahlberg, A: Airline passenger misconduct: Management implications for physicians. Aviat Space Environ Med 2007; 78(4):361–367.Google Scholar
Pointer, JE: Effect of standing orders on field times. Ann Emerg Med 1988;17(7):753. (Abstract).Google Scholar
Pointer, JE: The emergency physician and medical control in advanced life support. J Emerg Med 1985; 3(1):31–35.Google Scholar
Polsky, S, Krohmer, J, Maningas, P, McDowell, R, Benson, N, Pons, P: Guidelines for medical direction of prehospital EMS. American College of Emergency Physicians. Ann Emerg Med 1993; 22(4):742–744.Google Scholar
Pons, P: Medical control of prehospital care. J Emerg Med 1984; 1(5):449–450.CrossRefGoogle ScholarPubMed
Pons, PT, Holland, B, Alfrey, E, Markovchick, V, Rosen, P, Dinerman, N: An advanced emergency medical care system at National Football League games. Ann Emerg Med 1980; 9(4):203–206.Google Scholar
Poulton, TJ, Kisicki, PA: Medical directors of critical care air transport services. Crit Care Med 1987; 15(8):784–785.Google Scholar
Powers, R: Organization of a hospital-based victim decontamination plan using the incident command structure. Disaster Manag Response 2007; 5(4):119–123.Google Scholar
Pozen, MWD'Agostino, RB, Sytkowski, PAet al: Effectiveness of a prehospital medical control system: An analysis of the interaction between emergency room physician and paramedic. Circulation 1981; 63(2):442–447.Google Scholar
Rausch, PG, Ramzy, AI: Development of a palliative care protocol for emergency medical services. Ann Emerg Med 1991;20(12):1383–1386.Google Scholar
Ray, AM, Sole, DP: Emergency medicine resident involvement in EMS. J Emerg Med 2007; 33(4):385–394.CrossRefGoogle ScholarPubMed
Raymond, J: A mandatory off-line medical control workshop for advanced life support medical directors: description, initial results, and future plans. Ann Emerg Med 1988; 17(7):752–753. (Abstract).Google Scholar
Reed, DB, Gough, JE, Ho, JD, Brown, LH: Prehospital consideration of sildenafil-nitrate interactions. Prehosp Emerg Care 1999; 3(4):306–309.CrossRefGoogle ScholarPubMed
Reynolds, M, Thomsen, C, Black, L, Moody, R: The nuts and bolts of organizing and initiating a pediatric transport team. The Sutter Memorial experience. Crit Care Clin 1992;8(3):465–480.Google Scholar
Rhee, KJ, Strozeski, M, Burney, RE, Mackenzie, JR LaGreca-Reibling, K: Is the flight physician needed for helicopter emergency medical services? Ann Emerg Med 1986; 15(2):174–177.Google Scholar
Ricci, E, Pretto, E: Assessment of prehospital and hospital response in disaster. Crit Care Clin 1991; 7(2):471–484.CrossRefGoogle ScholarPubMed
Rinaca, C, Elnitsky, C, Brown, G: EMS agenda for the future: Virginia providers' perspectives. Prehosp Emerg Care 1999; 3(2):150–156.Google Scholar
Rinnert, KJ, Blumen, IJ, Gabram, SG, Zanker, M: A descriptive analysis of air medical directors in the United States. Air Med J 1999; 18(1):6–11.CrossRefGoogle ScholarPubMed
Roudsari, BS, Nathens, AB, Cameron, P, et al: International comparison of prehospital trauma care systems. Injury 2007;38(9):993–1000.Google Scholar
Sachs, GA, Miles, SH, Levin, RA: Limiting resuscitation: Emerging policy in the emergency medical system. Ann Intern Med 1991; 114(2):151–154.Google Scholar
Sanders, AB, Criss, E, Steckl, P, Meislin, HW, Raife, J, Allen, D: An analysis of medical care at mass gatherings. Ann Emerg Med 1986; 15(5):515–519.Google Scholar
Sayre, MR, Weisgerber, I: The use of neuromuscular blocking agents by air medical services. J Air Med Transp 1992; 11(1):7–11.Google Scholar
Schmidt, TA, Mann, NC, Federiuk, CS, Atcheson, RR, Fuller, D, Christie, MJ: Do patients refusing transport remember descriptions of risks after initial advanced life support assessment? Acad Emerg Med 1998; 5(8):796–801.Google Scholar
Schwartz, R, Jacobs, L, Lee, M: The role of the physician in a helicopter emergency medical service. Prehosp Disaster Med 1990;5:31–37.Google Scholar
Shah, MN, Fairbanks, RJ, Maddow, CLet al: Description and evaluation of a pilot physician-directed emergency medical services diversion control program. Acad Emerg Med 2006; 13(1):54–60.Google Scholar
Shanaberger, CJ: Medical control physicians and DNR orders. Ann Emerg Med 1988;17(7):751.Google Scholar
Shealy, RM, Simpson, WM Jr., Lee, FWet al: The gaping hole: physicians are missing from the front line of disaster preparedness training. J S C Med Assoc 2006; 102(1):11–13.Google ScholarPubMed
Shelton, SL, Swor, RA, Domeier, RM, Lucas, R: Medical direction of interfacility transports: National Association of EMS Physicians Standards and Clinical Practice Committee. Prehosp Emerg Care 2000; 4(4):361–364.CrossRefGoogle Scholar
Snow, N, Hull, C, Severns, J: Physician presence on a helicopter emergency medical service: necessary or desirable? Aviat Space Environ Med 1986;57(12 Pt 1):1176–1178.Google Scholar
Soler, JM, Montes, MF, Egol, AB, Nateman, HR, Donaldson, EA, Greene, HH: The ten-year malpractice experience of a large urban EMS system. Ann Emerg Med 1985; 14(10):982–985.Google Scholar
Spaite, DW, Valenzuela, TD, Meislin, HW: Physician in-field observation of prehospital advanced life support personnel: a statewide evaluation. Prehosp Disaster Med 1993; 8(4):299–302.Google Scholar
Stark, G, Hedges, JR, Neely, K, Norton, R: Patients who initially refuse prehospital evaluation and/or therapy. Am J Emerg Med 1990; 8(6):509–511.CrossRefGoogle ScholarPubMed
Stewart, RD, Burgman, J, Cannon, GM, Paris, PM: A computer-assisted quality assurance system for an emergency medical service. Ann Emerg Med 1985; 14(1):25–29.Google Scholar
Stewart, RD, Paris, PM, Heller, MB: Design of a resident in-field experience for an emergency medicine residency curriculum. Ann Emerg Med 1987; 16(2):175–179.Google Scholar
Stewart, RD: Prehospital care—Education, evaluation and medical control. Top Emerg Med 1980; 1(4):67–82.Google Scholar
Stone, RM, Seaman, KG, Bissell, RA: A statewide study of EMS oversight: Medical director characteristics and involvement compared with national guidelines. Prehosp Emerg Care 2000; 4(4):345–351.Google Scholar
Stone, CK: The air medical crew: Is a flight physician necessary? J Air Med Transp 1991; 10(11):7–10.Google Scholar
Storer, DL, Dickinson, ET: III Physician medical direction of EMS education programs: Policy resource and education paper. American College of Emergency Physicians (ACEP) Emergency Medical Services (EMS) Committee, and the National Association of EMS Physicians (NAEMSP) Standards and Clinical Practice Committee. Prehosp Emerg Care 1998; 2(2):158–159.Google Scholar
Stratton, SJ: Withholding CPR in the prehospital setting. Prehosp Disaster Med 1990;5:45.Google Scholar
Stueland, D, Patzner, MJ, Rauch, R: An assessment of prehospital provider needs in Wisconsin. Wis Med J 1995; 94(12):689–692.Google ScholarPubMed
Stueland, D, Patzner, MJ, Rauch, R, Birnbaum, ML: A self-assessment of Wisconsin prehospital provider needs. Prehosp Disaster Med 1997; 12(4):264–268.Google Scholar
Stults, KR: EMT-defibrillation in rural America. Physician Assist 1986;10(9):111.Google Scholar
Sucov, A, Verdile, VP, Garettson, D, Paris, P: The outcome of patients refusing prehospital transportation. Prehosp Disaster Med 1992;7:365–371.Google Scholar
Suffoletto, BP, Salcido, DD, Menegazzi, JJ: Use of prehospital-induced hypothermia after out-of-hospital cardiac arrest: a survey of the National Association of Emergency Medical Services Physicians. Prehosp Emerg Care 2008; 12(1):52–56.Google Scholar
Suy, K, Gijsenbergh, F, Baute, L: Emergency medical assistance during a mass gathering. Eur J Emerg Med 1999; 6(3):249–254.CrossRefGoogle ScholarPubMed
Swor, RA: Training of EMS medical directors: Current status. Ann Emerg Med 1988;17(7):754. (Abstract).Google Scholar
Tadmor, B, McManus, J, Koenig, KL: The art and science of surge: experience from Israel and the U.S. military. Acad Emerg Med 2006;13(11):1130–1134.Google Scholar
Tang, N, William, F: Medical direction and integration with existing EMS infrastructure (tactical emergency medical support). Top Emerg Med 2003; 24(4):326–332.Google Scholar
Thanel, F: Near drowning. Rescuing patients through education as well as treatment. Postgrad Med 1998; 103(6):141–153.Google Scholar
Thomas, F, Gibbons, H, Clemmer, TP: Air ambulance regulations: A model. Aviat Space Environ Med 1986; 57(7):699–705.Google Scholar
Thomas, SH, Williams, KA, Claypool, DW: Medical director for air medical transport programs. Prehosp Emerg Care 2002; 6(4):455–457.Google Scholar
Thomas, JB, Abo, BN, Wang, HE: Paramedic perceptions of challenges in out-of-hospital endotracheal intubation. Prehosp Emerg Care 2007; 11(2):219–223.Google Scholar
Thompson, BM: Physician-staffed mobile ICUs. Am J Emerg Med 1985;3(1):81.Google Scholar
Tortella, BJ, Lavery, RF, Cody, RP, Doran, J: Physician medical direction and advanced life support in the United States. Acad Emerg Med 1995; 2(4):274–279.Google Scholar
Uddin, SG, Barnett, DJ, Parker, CL, Links, JM, Alexander, M: Emergency preparedness: Addressing a residency training gap. Acad Med 2008; 83(3):298–304.Google Scholar
Van Buren, KL: Understanding and using prehospital emergency systems. Resid Staff Physician 1988; 34(9):49–53, 56.Google Scholar
Varkey, P, Poland, GA, Cockerill, FR III, Smith, TF, Hagen, PT: Confronting bioterrorism: physicians on the front line. Mayo Clin Proc 2002; 77(7):661–672.Google Scholar
Walker, CMHopkins, EW III: Role of the flight surgeon in fighter squadron Arctic deployments. Aviat Space Environ Med 1997; 68(2):137–141.Google Scholar
Wasserberger, J, Ordog, GJ, Donoghue, G, Balasubramaniam, S: Base station prehospital care: judgement errors and deviations from protocol. Ann Emerg Med 1987; 16(8):867–871.Google Scholar
Williams, A: Just when you thought you had nothing else to worry about—Medical director liability. Air Med J 2001;20(1):9.Google Scholar
Wirtz, DD, Ortiz, C, Newman, DHZhitomirsky, I. Unrecognized misplacement of endotracheal tubes by ground prehospital providers. Prehosp Emerg Care 2007; 11(2):213–218.CrossRefGoogle ScholarPubMed
Woodward, GA, Fleegler, EW: Should parents accompany pediatric interfacility ground ambulance transports? Results of a national survey of pediatric transport team managers. Pediatr Emerg Care 2001; 17(1):22–27.Google Scholar
Woodward, GA, Insoft, RM Pearson-Shaver, ALet al: The state of pediatric interfacility transport: consensus of the second National Pediatric and Neonatal Interfacility Transport Medicine Leadership Conference. Pediatr Emerg Care 2002; 18(1):38–43.CrossRefGoogle ScholarPubMed
Wuerz, RC, Swope, GE, Holliman, CJVazquez-de, MG: On-line medical direction: A prospective study. Prehosp Disaster Med 1995; 10(3):174–177.Google Scholar
Wydro, GC, Cone, DC, Davidson, SJ: Legislative and regulatory description of EMS medical direction: A survey of states. Prehosp Emerg Care 1997; 1(4):233–237.Google Scholar
Yancey, AH, Martinez, R, Kellermann, AL: Injury prevention and emergency medical services: The “Accidents Aren't” program. Prehosp Emerg Care 2002; 6(2):204–209.Google Scholar
Boyle, MF, De Lorenzo, RA, Garrison, R: Physician integration into mass gathering medical care. The United States Air Show. Prehosp Disaster Med 1993; 8(2):165–168.Google Scholar
Curiel, TJ: Murder or mercy? Hurricane Katrina and the need for disaster training. N Engl J Med 2006;355(20):2067–2069.Google Scholar
Poultan, TJ, Gutierrez, PJ, Schwabe, DJ: Physicians' role in aeromedical transport questioned. Ann Emerg Med 1987;16(12):1412–1413.Google Scholar
Control of medical emergency services at the scene of a medical emergency. Ohio State Med J 1984;80(12):829,832–33,846.Google Scholar
EMS workshop: Proper allocation and use of ALS (advanced life support) resources. Paramed Int 1979; 4(3):32–34.Google Scholar
Amey, BD, Straub, EJ, Harrison, EE: Medical control of paramedic services. Emerg Med Serv 1978; 7(4):20,22–20,23.Google Scholar
Barishansky, RM, O'Connor, K: Docs on demand. Emerg Med Serv 2006; 35(6):44–51.Google Scholar
Becknell, J: The benevolent dictator. A new breed of medical director. JEMS 1997; 22(7):36–40.Google Scholar
Blackwell, TH: Prehospital care. Emerg Med Clin North Am 1993; 11(1):1–14.Google Scholar
Busko, J, Margolis, GS, Politis, J: Professional medical direction. It's not too much to ask. JEMS 2006; 31(3):92–99.Google Scholar
Carmona, R, Rasumoff, D: Inside the perimeter: Essentials of tactical emergency medical support. The Tactical Edge 1990;54–56.Google Scholar
Dinerman, N: Forging new paths in medical control. JEMS 1990;15(8):S14–S19.Google Scholar
Eastham, JN Jr.: Assuring quality from the ground up. JEMS 1991; 16(5):48–4, 59.Google ScholarPubMed
Erich, J: What's-up docs. Emerg Med Serv 2006; 35(6):33–34,36,38.Google Scholar
Ferko, JG III: Why EMS needs physicians. Physician's role in prehospital EMS. JEMS 1987; 12(9):51–57.Google Scholar
Frank, M: Medical director vs. fire chief. JEMS 1984; 9(6):46–48, 55.Google Scholar
Funk, D: 10 minutes with Deb Funk, MD, FACEP, NREMT-P. Interview by Raphael Barishansky. Emerg Med Serv 2004;33(2):28,31.Google ScholarPubMed
Gates, WH: Prehospital emergency medical care in Ohio. Ohio State Med J 1978; 74(8):495–496.Google Scholar
Golin, CB: How MDs would improve emergency medical care in flight. Am Med News 1980; 23(29):9–10.Google Scholar
Gordon, D, Saussy, J, Frascone, RJ, Fowler, R, Racht, E: Profiles in leadership [interview by Teresa McCallion and Keri Losavio]. JEMS 2005;30(10):suppl 33.Google Scholar
Graham, DH: Documenting patient refusals. Emerg Med Serv 2001; 30(4):56–60.Google Scholar
Grotewiel, B: What makes an effective administrator?. Interview by LaTresa Costello. Emerg Med Serv 1990;19(1):14,56.Google Scholar
Gunderson, M, Barnard, J, McPherson, J, Kearns, CT: The medical communications officer. A resource for data collection, quality management and medical control. Emerg Med Serv 2002; 31(8):69–75.Google Scholar
Gunter, MJ, Ricci, EM, Silverman, M, Rawson, IG, Esposito, G: Physician involvement: A critical factor in the development of community emergency medical services. Emerg Med Serv 1979;8(3):48,50–48,60.Google Scholar
Hall, JE: Prehospital care and the physician intervener. Alaska Med 1985; 27(4):98–100.Google ScholarPubMed
Henry, MC, Stapleton, ER: EMTs and medical control. JEMS 1985; 10(1):32–34.Google Scholar
Jaslow, D, Lemecha, D: Prehospital pharmacology: Nitrous oxide. Emerg Med Serv 2007; 36(2):71–73.Google ScholarPubMed
Krohmer, JR: Medical director. The patient's best advocate. JEMS 1997; 22(7):42–44.Google ScholarPubMed
Krentz, MJ, Wainscott, MP: Medical accountability. Emerg Med Clin North Am 1990; 8(1):17–32.Google Scholar
Kuehl, AE: Passing the torch. Emerg Med Serv 1991;20(5):64,66,88.Google Scholar
Latessa, EM: The physician medical director: A guideline for the roles and responsibilities in a prehospital advanced life support service. JEMS 1981; 6(4):46–47.Google Scholar
Lilja, GP, McSwain, NE Jr., Post, CJ, Snow, N, Stewart, CE, Winer, LD: The role of EMS medical directors. Emerg Med Serv 1986;15(2):38,40–38,49.Google Scholar
Lonchena, T: The three R's: reciprocity, recertification and registry. Emerg Med Serv 2002; 31(12):55–56.Google Scholar
Ludwig, G: How do you get along with your medical director? JEMS 2006;31(11):20.Google Scholar
Martinez, JM: Medical coverage of cycling events. Curr Sports Med Rep 2006; 5(3):125–130.CrossRefGoogle ScholarPubMed
Matera, PA: Move over EM docs. JEMS 2006;31(6):16.Google Scholar
Matera, PA: Medical director. Doc on the street: Another view. JEMS 1997; 22(7):48–49.Google ScholarPubMed
McSwain, NE Jr.: Controversies in prehospital care. Emerg Med Clin North Am 1990; 8(1):145–154.Google Scholar
Meador, SR, Slovis, CM, Wrenn, KD: EMS Bill of Rights: What every patient deserves. JEMS 2003; 28(3):70–75.Google Scholar
Miller, K. On-board docs. Emergency 1988; 20(7):47–48.Google Scholar
Newman, BG: EMS medical control: doctor-shoppers need not apply. JEMS 1982; 7(11):43–44,46.Google Scholar
Nicholson, WC: Medical director. Liability risks: fact or fiction? JEMS 1997; 22(7):44–47.Google Scholar
Page, JO: Whose license is it anyway? JEMS 1999; 24(5):92.Google ScholarPubMed
Polsky, SS, Weigand, JV: Quality assurance in emergency medical service systems. Emerg Med Clin North Am 1990; 8(1):75–84.Google Scholar
Riggins, WS Jr.: Tackling disaster: Medicine's “trusted agent” role becomes evident. Tex Med 2005; 101(11):7–8.Google Scholar
Riner, RM: Developing medical control in a rural EMS system. Emerg Med Serv 1981; 10(2):22–28.Google Scholar
Sacra, JC, Murphy, M: Oklahoma City and Tulsa Metropolitan Medical Response System. J Okla State Med Assoc 2002; 95(4):281–285.Google ScholarPubMed
Shanaberger, CJ: Determining domain. The issue of medical control. JEMS 1991; 16(7):107–108.Google Scholar
Shanaberger, CJ: No heroics. Whose wish is your command? JEMS 1989; 14(9):99–102.Google Scholar
Shanaberger, CJ: Medical-control physicians and DNR protocols. Emerg Med Serv 1989; 18(3):53–45,55.Google ScholarPubMed
Stensrud, KM: Floodwaters bring docs to the front. Minn Med 1997; 80(8):14–19.Google Scholar
Stewart, RD: Medical direction in emergency medical services: The role of the physician. Emerg Med Clin North Am 1987; 5(1):119–132.Google Scholar
Suter, RE: Community relations and organizations. Emerg Med Clin North Am 2004; 22(1):183–194.Google Scholar
Taylor, B: Is your EMS system cutting edge? JEMS 1994; 19(10):54–60.Google Scholar
Timmermann, A, Russo, SG, Hollmann, MW: Paramedic versus emergency physician emergency medical service: role of the anaesthesiologist and the European versus the Anglo-American concept. Curr Opin Anaesthesiol 2008; 21(2):222–227.Google Scholar
Tripoli, L: Disaster communications: Functional considerations for EMS communications systems. JEMS 2002; 27(10):62–73.Google ScholarPubMed
White, RD: AED (automated external defibrillators). A physician's responsibility. JEMS 1992; 17(4):8–9.Google Scholar
Salomone, J: Ethics in EMS. Making choices you and your patients can live with. JEMS 1989; 14(5):28–25.Google Scholar
American College of Emergency Physicians: Control of advanced life support at the scene of medical emergencies. Ann Emerg Med 1984; 13(7):547–548.Google Scholar
American College of Emergency Physicians: Direction of prehospital care at the scene of medical emergencies. Ann Emerg Med 1994;23(5):1145–1146.Google Scholar
EMS Committee, American College of Emergency Physicians: Emergency ambulance destination. Ann Emerg Med 1999;34(1):128.Google Scholar
Emergency physicians' patient care responsibilities outside the emergency department. Ann Emerg Med 2006;47(3):304.Google Scholar
Committee on Pediatric Emergency Medicine, American Academy of Pediatrics: Emergency preparedness for children with special health care needs. Pediatrics 1999;104(4):e53.Google Scholar
A special contribution of the Ethics Committee, National Association of Emergency Medical Services Physicians: Ethical challenges in emergency medical services. Prehosp Disaster Med 1993; 8(2):179–182.Google Scholar
Equipment for ambulances. Ann Emerg Med 2001;37(5):557.Google Scholar
American College of Emergency Physicians: Guidelines for ‘do not resuscitate' orders in the prehospital setting. Ann Emerg Med 1988;17(10):1106–1108.CrossRefGoogle Scholar
Guidelines for emergency medical services systems. Ann Emerg Med 1988; 17(7):742–745.CrossRefGoogle Scholar
Guide for preparing medical directors. Ann Emerg Med 2002; 39(4):450–451.Google Scholar
Mass participation event management for the team physician: A consensus statement. Med Sci Sports Exerc 2004;36(11):2004–2008.Google Scholar
American College of Emergency Physicians: Medical control of prehospital emergency medical services. Ann Emerg Med 1982; 1(7):387.Google Scholar
Medical direction and medical control of air medical services: Position statement of the Air Medical Physician Association approved by the AMPA Board of Trustees October 1998, revised April 2002. Air Med J 2003; 22(1):14–15.CrossRefGoogle Scholar
Medical direction and medical control of air medical services. Position statement of the Air Medical Physician Association. Prehosp Emerg Care 2002; 6(4):461–463.CrossRefGoogle Scholar
American College of Emergency Physicians: Medical direction of emergency medical services. Ann Emerg Med 1998;31(1):152.Google Scholar
Medical direction of prehopsital emergency medical services. Ann Emerg Med 1993;22(4):767.Google Scholar
EMS Committee: Medical direction for staffing of ambulances. Ann Emerg Med 1999; 34(3):421–422.Google Scholar
Medical direction for staffing of ambulances. Ann Emerg Med 2006;47(3):305.Google Scholar
Air Medical Committee, National Association of Emergency Medical Services Physicians: Medical director for air medical transport programs. Prehosp Disaster Med 1995; 10(4):283–284.Google Scholar
American College of Emergency Physicians: Physician medical direction of emergency medical services dispatch programs. Ann Emerg Med 1999;33(3):372.Google Scholar
American College of Emergency Physicians: Physician medical direction of emergency medical services education programs. Ann Emerg Med 1998; 31(1):153–154.Google Scholar
The role of the pediatrician in rural emergency medical services for children. Pediatrics 2005;116(6):1553–1556.Google Scholar
Role of state EMS medical director. Ann Emerg Med 2005;46(1):103.Google Scholar
Position statement. Role of the State EMS Medical Director. Prehosp Emerg Care 2005;9(3):338.Google Scholar
The role of emergency physicians in emergency medical services for children. Ann Emerg Med 2002;37(4):428.Google Scholar
American Academy of Pediatrics, Committee on Pediatric Emergency Medicine: The role of the pediatrician in rural EMSC. Pediatrics 1998; 101(5):941–943.Google Scholar
Committee on Trauma and Committee on Shock. Accidental Death and Disability: The Neglected Disease of Modern Society. National Academy of Sciences. 1966.Google Scholar
Figure 0

Table 1 Search strategies (EMS = emergency medical services)

Figure 1

Figure 1 Flow of articles from initial search to final data sets (EMS = emergency medical services)

Figure 2

Table 2 Articles published in non-peer-reviewed journals

Figure 3

Table 3 Position statements/governmental reports

Figure 4

Figure 2 Number of peer-reviewed, non-peer-reviewed, and position statements/governmental reports related to the physician's role in EMS, 1978 to 2008

Figure 5

Table 4 Growth of peer-reviewed articles compared to nonpeer reviewed articles

Figure 6

Table 5 Proportion of quantitative versus qualitative articles in the peer-reviewed set

Figure 7

Appendix Articles published in peer-reviewed journals