EMS Subspecialty

[P_Instructor]

Does anyone have insite to what this really means to the EMS provider?

EMS Approved as an Emergency Medicine Subspecialty

East Lansing, MI – September 28, 2010 -- The American Board of Emergency Medicine (ABEM) announces that the subspecialty of Emergency Medical Services (EMS) was approved by the American Board of Medical Specialties (ABMS) at the General Assembly of its members on September 23, 2010. EMS is a medical subspecialty that involves prehospital emergency patient care, including initial patient stabilization, treatment, and transport in specially equipped ambulances or helicopters to hospitals.

“The purpose of subspecialty certification in EMS is to standardize physician training and qualifications for EMS practice, to improve patient safety and enhance the quality of emergency medical care provided to patients in the prehospital environment, and to facilitate further integration of prehospital patient treatment into the continuum of patient care. We are pleased that EMS has been recognized by ABMS as a clinical discipline that extends emergency care to the acutely ill and injured patient in the prehospital venue.” stated Mark T. Steele, M.D., ABEM President.

EMS becomes the sixth subspecialty available to ABEM diplomates along with Medical Toxicology, Pediatric Emergency Medicine, Sports Medicine, Undersea and Hyperbaric Medicine, and Hospice and Palliative Medicine. The development of EMS as a subspecialty has been discussed for many years but it was through the concerted efforts of the National Association of EMS Physicians, the American College of Emergency Physicians, the Society for Academic Emergency Medicine, and ABEM that certification in the subspecialty was approved.

ABEM has assembled an EMS Examination Task Force composed of 12 EMS physicians that is working on the development of the EMS subspecialty examination and maintenance of certification program. It is anticipated that the first examination will be given in the fall of 2013.

[tcripp]

At first glance, this tells me that we are being recognized as a part of the medical chain and not just ambulance drivers. I can see this being a good thing.

[JPINFV]

There really isn't going to be much of a change at the ground level. What it does do is lay the ground work for requiring an EMS subspecialization to be medical director.

[Richard B the EMT]

What it does do is lay the ground work for requiring an EMS subspecialization to be medical director.

Do you also see it as possibly becoming a requirement for being a Doctor in an On Line Medical Control center? Either way, it seems to be a good thing.

[Lone Star]

Hopefully, since EMS is now being recognized as a subspecialty in the medical field, that it will lay the groundwork to get us moved from the control of the Department of Transportation, National Highway Traffic Safety Administration and put where we belong.....governed by a MEDICAL organization.

Once that happens, we can start pushing for higher educational standards, and possibly begin to look at being recognized as a PROFESSION and not just 'another job'.

[JPINFV]

Do you also see it as possibly becoming a requirement for being a Doctor in an On Line Medical Control center? Either way, it seems to be a good thing.

For online medical control? Probably not. My understanding is that the majority of the components of the fellowship are designed towards system design and QA/QI, which the average online medical control physician is not engaged in. However, there should be some sort of local requirement for introduction into the system, training, and ride alongs if a system uses specific people to provide online medical control (e.g. Mobile Intensive Care Nurses (MICN) in California).

[Doczilla]

At this point, it means very little to the average EMS provider. This determination means that physicians may board certify in EMS after completing an EMS fellowship. This is similar to a doctor completing internal medicine residency, then doing a cardiology fellowship to become a cardiologist.

Initially many physicians will be "grandfathered" in without the fellowship if they have substantial relevant experience in EMS, but nobody knows yet what that will entail. When emergency medicine started out as a specialty, most physicians who worked in the ER were not residency trained in emergency medicine. Because the residency wasn't available when they had initially trained, and because the had a good deal of experience in the specialty, they were allowed to sit for the board exam in emergency medicine. The requirements to allow this got tighter over time, and finally was not allowed, so now you can board certify in emergency medicine only if you have completed an emergency medicine residency.

The ABMS board certification in EMS is not for your average ER doc who may give online medical control. It is more for physicians in an administrative role, usually for larger systems. It will certainly qualify physicians to do field response, though you don't see this often in your average EMS service. I don't think we will get to the point that all EMS medical directors are board certified, as the demand would far outstrip the supply. Larger cities will likely start requiring it.

There are EMS fellowships currently, but nobody can board certify until the exam is created, which requires setting forth the training requirements (not easy to put down on paper EVERYTHING you want them to learn in a year or two) and prerequisites for board certification. with no board certification, it is tough to convince a doc who has completed residency to endure another year or two of fellowship with little professional recognition on the other side of it when they could be making 4 times as much money. Therefore, many EMS fellowships can be done in conjunction with an MPH.

What I hope this will accomplish:

Better recognition of the need for specialized training for physicians providing medical direction.

Hopefully better pay for physicians doing EMS medical direction. Many EMS systems want much of their medical director, but compensate very little (if anything) for their time. It is usually seen as a "hobby" by the hospital or physician's group, discretionary and subservient to all other employee responsibilities. As a recognized medical specialty, the physician is in a better position to demand some FTEs for the work he does.

Better expectations of medical direction. Many states allow any licensed physician of any specialty to be an EMS medical director. The quality or level of involvement therefore varies greatly from one medical director to another. With board certification, the physician has dedicated substantial time to the specialty, and is less likely to be an absentee medical director.

Better funding for EMS research.

More opportunities for full time EMS medical director jobs.

'zilla