Updated AAEM Position Statement on Emergency Medical Services (2005)
The American Academy of Emergency Medicine believes that patients requiring emergency care need universal access to both high quality pre-hospital and emergency department based medical care. AAEM recognizes the vocation of pre-hospital medicine to include patient advocacy and transportation of patients to facilities best able to deliver the services they require. AAEM also recognizes the roles of EMS Medical Directors or EMS physicians as being rooted in Public Health. The responsibility of EMS physicians serving the community should be independent from the financial or political interests of any private institution or other entity within a health care delivery system.
Competent emergency medical care begins in the field. In this setting, patients are best served by a team consisting of certified or licensed emergency medical technicians and first responders at the various levels of training, as provided by the resources and regulations of their municipality and State. Each EMS system should operate under the medical oversight of a qualified physician familiar with emergency care.
The ideal system is best conceived and maintained in an environment where EMS medical directors and the local emergency physicians with whom they collaborate are well trained, and the latter are part of a stable Emergency Medicine practice in the community which they serve. Medical oversight will better ensure that local EMS receives the best guidance in the evaluation, training and implementation of the latest technologies, skills and practices most appropriate for local citizens. Moreover, emergency medicine specialists have the best training to help achieve integration of an EMS system into its community's larger overall system of emergency care.
In the modern era, the Medical Director must have state licensures, board certification in emergency medicine by ABEM or AOBEM and possess expertise in EMS systems. Medical Director positions should be vested with the authority to intervene in any issues that impact or are the result of the delivery of out of hospital patient care. Therefore, subsystems within EMS over which the physician should have advisory roles or absolute authority include scope of practice, quality management, dispatch protocols, education, protocol development and disaster or mass gathering planning. Fellowship training now offered in Emergency Medical Services provides the most comprehensive instruction available in all aspects of EMS .
Finally, municipal leaders and EMS agencies should recognize EMS oversight services as a vocation and necessity for public health. As such, Medical Directors should be supported with the necessary resources to function effectively given the size and demographics of the system. These include but are not limited to supportive legislation, a budget for the position to include a reasonable stipend for labor and/or expenses, legal protections for specified duties, as well as reasonable due process to prevent the arbitrary dismissal of physicians without justification. Such an approach will nurture the same quality of services in the pre-hospital setting as is expected from other areas of health care delivery, and the same citizen benefit delivered by other physicians in the public service sector.