Docs on Demand

     Doctors riding ambulances isn't common in the U.S., but some in EMS believe they can be an asset in the field, bringing capabilities and education beyond paramedics', to the benefit of patients. The New Jersey EMS Task Force's Physician Response Team, MD-1, is a specialty resource that can be called to assist with triage and treatment and provide medical consultation to providers at disaster and major emergency scenes.

     The team began in 2005 as a small-scale 24-hour physician response program at a community hospital. It was based on models in New York City and Pittsburgh, and while it initially covered only a small geographic area, its architects hoped to grow it into a statewide program.

     An initial vehicle was donated by a car dealership. A six-month process ensued to obtain blood licensure and equipment, including monitors, surgical equipment, point-of-care testing products and intubation devices. Local donors provided significant help. The vehicle—a Ford Expedition labeled EMS Physician and decaled with New Jersey EMS Task Force emblems—was designed, arranged and made operative. The local hospital was unwilling to cover residents under the program due to insurance reasons, so the emergency department insurance policy was rewritten to include prehospital coverage for attending physicians. We anticipated that several physicians and an EMS Fellow would train on the vehicle, and eventually cover all of New Jersey. The criteria to call the unit would be either delayed on-scene time (greater than one hour or as judged by EMS) or at the request of any local ALS agency.

     One key capability docs would bring to the field would be the ability to give blood. A prehospital blood transfusion license was obtained from the state Department of Health and Senior Services, and a protocol was written to cover transfusion indications, reactions and refrigeration techniques. A portable refrigerator was mounted in the vehicle, with a temperature probe to assure the temperature was maintained at 2°–8°C 24 hours a day. A secondary battery powered the refrigerator, and a shore line was built into the vehicle to plug in when a physician took the vehicle home.

     One goal of the project was to have state EMS providers view this vehicle as a specialty response resource with capabilities beyond those of a typical paramedic vehicle. At first the idea was met with resistance by people who'd had bad experiences with prehospital physicians. It was important that the New Jersey prehospital community's mind-set become more receptive to the concept. Some of this was accomplished by making people aware of outstanding physicians-in-the-field programs that already exist nationally. Brochures were sent to EMS agencies to make them aware of the service and how it could be used.

     In the first six months of the program, the vehicle was requested 34 times and made it on scene 12. The other 22 times, it was appropriately canceled when the patient left the scene with EMS prior to physician arrival. Two responses resulted in giving packed red blood cells to patients in hypovolemic shock. One patient required a surgical cricothyroidotomy for severe facial burns, and one received a fiberoptic intubation after other EMS intubation techniques failed.

     In 2006 the MD-1 program was integrated into the New Jersey EMS Task Force. The EMSTF is a state Office of EMS response resource for large-scale emergencies and high-profile events that consists of specialized teams designed to fill gaps in EMS capabilities. Its areas of support include incident management, mass care, hazmat, tactical, search and rescue, communications and more. Under the EMSTF response plan, the state is divided into three regions (North, Central and South), each with an "anchor" agency. Activation occurs through the North Regional Dispatch Center. (For more on the New Jersey EMS Task Force, see www.EMSResponder.com/onlineexclusives.)