EFFECT OF FULL-TIME, SPECIALIZED PHYSICIAN SUPERVISION ON THE SUCCESSOF A LARGE, URBAN EMERGENCY MEDICAL-SERVICES SYSTEM

Objectives: Despite the universal proliferation of emergency medical s ervices programs throughout the United States since 1970, only a few h ave ever documented a valid lifesaving effect, particularly in- large, urban centers. The purpose of this study was to demonstrate the effec t of specialized physician supervision on the effectiveness of an emer gency medical services system. Design. Prospective, cohort study. Sett ing. Large, urban municipality (population 2 million). Patients: Evalu ation of victims of out-of-hospital sudden cardiac death cases, before (n = 152) and after (n = 200) the introduction of specialized physici an supervision for the emergency medical services system. Intervention s. The hiring of a full-time, salaried emergency medical services syst em physician whose principal duties would be to provide intensive indi vidualized training, direct operational supervision, and continuous sy stem monitoring, including frequent on-scene oversight of emergency me dical services personnel. Measurements and Main Results: Comparison of existing hospital discharge rates for out-of-hospital sudden cardiac death cases to those rates achieved 5 yrs after recruitment of the spe cialized emergency medical services system physician. A dramatic incre ase in hospital discharge rates was demonstrated for sudden death pati ents presenting with ventricular fibrillation, from zero at year 0 (0 of 152 patients survived), to 21% (42 of 200 patients) by year 5 (p < .001). This result was achieved despite the fact that all other relate d factors (budget, paramedic numbers, response times) significantly wo rsened during the comparison periods. Conclusions: The introduction of the new factor into the emergency medical services system (specialize d physician supervision) was associated with significantly improved pa tient outcome. In view of current suboptimal outcome statistics found in most municipal emergency medical services programs across the Unite d States, future goals of medical community leaders should be directed at efforts to properly train, certify, and establish appropriate posi tions for physicians who specialize in emergency medical services syst em supervision.