Now That Doctors Specialize in EMS, Shouldn’t We?

Last Sunday the EMS gods were nice enough to me to wait until after EMS Office Hours to punish me, so that I could join Jim and Josh for a great discussion about one community considering combining fire, police, and EMS into one service.   We also talked about Community Paramedics, which would create a specialty area for EMS to branch into.

This raises two fundamental questions about what EMS is and what it should be.  Have the responsibilities of EMS grown large enough to warrant dedicating people to specialize in its delivery, or is it an ancillary activity to another mission?

Medical directors seem to have recognized what many of us have been saying – that they don’t fully grasp our strengths and limitations.  This is  from Dr. Ray Fowler’s website:

“EMS Medical Direction is a part-time job for so many EMS docs, who also do it for free. The overwhelming majority of people who come to this meeting don’t have EMS as the primary part of their practice.” – Jeff Goodloe

Sound familiar? In many communities, the lead EMS providers are also responsible for firefighting, or do it as a hobby outside of their primary job.  This is an excerpt from Dr. Mickey Eisenberg’s book Resuscitate: How to Improve Survival from Sudden Cardiac Arrest:

Dual-training an individual to be both a firefighter and a paramedic, and then expecting stellar performance in both jobs, reflects a hope based on what is probably a flawed concept.  Do we dual-train doctors as police officers? …The point is that paramedics must be allowed to learn the skills they need and then to hone them as professionals.  This is not to say that they cannot work within fire departments, but only that, except in emergencies, they should not be expected to perform the duties of firefighters.

In 2010, the American Board of Medical Specialties formally recognized EMS as a subspecialty – for physicians. This is from EMS1:

“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,” said Mark T. Stelle, M.D., President of the American Board of Emergency Medicine Board of Directors.

I think it’s great that physicians interested in overseeing EMS can now specialize in it, but we’re the ones going on calls every day.  We need to accept more responsibility for our performance, from figuring out what the best treatment is,  measuring how well that treatment is delivered, and adjusting operations so  it is delivered consistently.   So my question is, how many hats can we be expected to wear and provide excellent care? Can communities to rely on volunteers do this in addition to their full-time job?

With all the choices available to physicians, we are lucky to have a few who choose to specialize in EMS.  If we want to be respected as a profession, we need to do the same.


  1. Agreed. The hot topic in this area is Community Paramedicine. We are very involved in this area. See:

  2. Skip Kirkwood says:

    Physicians have made it possible for members of their PROFESSION to specialize in emergency medicine, and to further SUB-SPECIALIZE in EMS.

    Before we can get to specialize and sub-specialize, we have to have a PROFESSION to begin with.

    So what is a profession? One definition is “a calling requiring specialized knowledge and often long and intensive academic preparation.” That, we are emphatically NOT. The recognized attributes of a profession are well described here:

    We have high-school or at best trade school education. We have no distinct body of knowledge. We resist education and entry standards. We are, as a nationwide body (in the U.S.), someplace between a hobby and a trade or vocation. Profession? I with, but I don’t think so.

    Our colleagues in Australia now require a bachelor’s degree as entry level. In Canada, it’s an associate degree. In the U.S., in too many places, it’s a few hours in a puppy mill and “take enough practice tests to squeak past a too-easy national or state exam”. Then, it’s off to a low-wage job that most people stay in just long enough to finance their escape to a higher paying job or, perhaps, a real profession.

    Until we open our eyes and come to grips with the actual status in which we are held by other health professions, and our communities at large, and WE THE EMS COMMUNITY do something to change that, we will stay “ambulance drivers” in the mind of most.

    Why are paramedics in Australia the #1 most trusted profession; in Canada the #2 most trusted profession, and in the United States, NOT EVEN ON THE LIST!

    Time to wake up, folks!

  3. Mark Whitehead says:

    My experience is as a Community First Responder in the UK. (A CFR is an unpaid volunteer with training who can be called to a medical emergency to give basic assistance, including defib, until the professionals arrive.)

    Our paramedics, though not all degree-level, have a long and thorough practical and theoretical training in all aspects of pre-hospital care.

    Our fire-fighters are also highly trained – in fire fighting, with a little First Aid thrown in.

    • emspatientperspective says:

      Thanks Mark!

      The UK, along with Canada and Australia, are way ahead of the United States in many areas.


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