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.)
MD-1 is now funded and supported with the same monies as the EMSTF. A fully loaded EMS physician response vehicle is based out of the Central Region, and we are preparing to add one in the North. The vehicle has a blood bank license, the latest fiberoptic intubation equipment, large numbers of Mark I kits, and a vast supply of surgical equipment and medications. Twenty physicians throughout the state have signed up for the program, and five have completed the training at the time of this writing. Most have significant prehospital experience or are going through training. Currently, the MD-1 vehicle remains with the on-call physician and is dispatched on all Task Force activations and for any New Jersey agency that believes it would be beneficial to have it on scene.
Physician Go-Team Medical Officer Position Description
The Physician Go-Team Medical Officer position oversees and provides direct medical care to disaster victims, as well as coordinates activities with local physician resources. The Physician Go-Team Medical Officer may also provide medical consultation to other healthcare providers. The Physician Go-Team Medical Officer reports directly to the Medical Team Operations Manager.
Description of Duties
- Supervises the overall flow of victims and medical care provided by task force medical personnel;
- Supervises subordinates;
- Counsels medical personnel on the handling of difficult cases and resolution of intensive treatment problems;
- Supervises the diagnosis and treatment of victims using disaster care medicine;
- Supervises the triage of patients on entry to medical services;
- Performs major medical care that requires a licensed physician;
- Refers patients for further consultation and treatment when necessary;
- Identifies conditions requiring urgent surgical intervention and makes referral for service;
- Supervises medical treatment administered by other professional and technical personnel to assure that adequate professional and technical services are provided;
- Recommends methods and procedures for coordination of medical services with other medical activities;
- Ensures all patient records are complete and submitted to the Medical Team Operations Manager;
- Prepares performance evaluations for assigned personnel.
- Doctor of Medicine or Doctor of Osteopathy (U. S. or Canada), or foreign medical graduate with unrestricted licensure to practice medicine;
- Valid and unrestricted state licensure to practice medicine;
- Board-eligible or board-certified in clinical specialty with ATLS/ACLS/CPR;
- Extensive knowledge of ICS;
- Extensive knowledge of personnel management and supervision;
- Extensive knowledge of universal precautions;
- Extensive knowledge of methods of support for disaster victims;
- Extensive knowledge and experience in the prehospital setting.
New Jersey EMS Task Force
After 9/11, gaps in EMS response capabilities couldn't be tolerated. Regional emergency medical response frameworks had to include specialized resources for a variety of unique areas—things like hazmat response, urban search and rescue, interoperable communications and more. How could EMS officials fill such gaps in a flexible and cost-effective way?
In New Jersey, the solution was to create an EMS Task Force consisting of modules of specially trained and equipped providers that could be summoned as needed for EMS responses, be they to major disasters or just challenging everyday calls. Drawn from existing state resources, the task force can assist overwhelmed locals in areas like incident management, mass care, hazardous materials, structure collapse, tactical situations, planning, training and more. The physician go-team is part of this well-rounded arsenal.
Today the New Jersey EMS Task Force consists of more than 200 members, coming from 40 agencies. Working closely with the state EMS office, the group has provided support for events like the 2004 Republican National Convention and events at the U.N. General Assembly, as well as federal, state and local exercises. It has also responded for out-of-state emergencies like Hurricane Katrina.
For more on this EMS response resource, see www.EMSResponder.com/onlineexclusives.
Mark A. Merlin, DO, EMT-P, FACEP, is medical director for the New Jersey EMS Task Force's Physician Response Team and EMS medical director at the Robert Wood Johnson University Hospital, New Brunswick, NJ. He chairs the state Department of Health and Senior Services' MICU Advisory Council.
John J. Grembowicz, Sr., EMT-P, is a leader of the New Jersey EMS Task Force and associate director of the University of Medicine and Dentistry of New Jersey's University Hospital EMS.
Henry P. Cortacans, MICP, NREMT-P, is a planner for the New Jersey EMS Task Force.
William Gluckman, DO, EMT-P, FACEP, is medical director for the New Jersey EMS Task Force and EMS medical director at University Hospital in Newark. He is vice chair of the state Department of Health and Senior Services' MICU Advisory Council.
Louis A. Sasso, MBA, NREMT-P, is a leader of the New Jersey EMS Task Force and EMS director at Robert Wood Johnson University Hospital.