Effect of full-time, specialized physician supervision on the success of a large, urban emergency medical services system

Objectives: Despite the universal proliferation of emergency medical services programs throughout the United States since 1970, only a few have ever documented a valid lifesaving effect, particularly in large, urban centers. The purpose of this study was to demonstrate the effect of specialized physician supervision on the effectiveness of an emergency medical services system. Design: Prospective, cohort study. Setting: Large, urban municipality (population 2 million). Patients: Evaluation of victims of out-of-hospital sudden cardiac death cases, before (n = 152) and after (n = 200) the introduction of specialized physician supervision for the emergency medical services system. Interventions: The hiring of a full-time, salaried emergency medical services system physician whose principal duties would be to provide intensive individualized training, direct operational supervision, and continuous system monitoring, including frequent on-scene oversight of emergency medical 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 specialized emergency medical services system physician. A dramatic increase in hospital discharge rates was demonstrated for sudden death patients 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 related factors (budget, paramedic numbers, response times) significantly worsened during the comparison periods. Conclusions: The introduction of the new factor into the emergency medical services system (specialized physician supervision) was associated with significantly improved patient outcome. In view of current suboptimal outcome statistics found in most municipal emergency medical services programs across the United States, future goals of medical community leaders should be directed at efforts to properly train, certify, and establish appropriate positions for physicians who specialize in emergency medical services system supervision.