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Protocol for Emergency Medical Services Personnel

At the 2004 Annual Meeting, the AMA House of Delegates adopted the recommendation of the Council on Scientific Affairs to refer AMA Policy H-130.989, Protocol for Emergency Medical Service Personnel , for further study as part of the Sunset Report process.  This report addresses the adequacy of Policy H-130.989 and recommends amending it. 

Discussion

The proposed change of the policy’s title to “Protocol for Emergency Medical Services (EMS) Personnel and the Bystander Physician” indicates that the policy addresses not only EMS personnel, but the interaction between EMS personnel and physicians who happen upon the scene of an emergency and desire to intervene and render medical assistance.  The term “bystander physician” is defined and used throughout the revised policy statement to facilitate interpretation of the policy’s guidelines, and to make the important distinctions between bystander physicians and EMS physicians, and between bystander physicians and non-EMS physicians who may be called to the scene of an emergency to treat patients with whom they have an established clinical relationship.

Additional changes are proposed to update this now 20-year old policy, and to increase its concordance with similar, more recent policies of EMS physician specialty societies; namely, the American College of Emergency Physicians (ACEP) and the National Association of EMS Physicians (NAEMSP).  These changes include: adding language in recognition of existing state and local policies on this topic; articulating that bystander physicians should work collaboratively with EMS providers, respecting EMS protocols and standing orders, rather than take control from said parties; and emphasizing that the bystander physician may need to accompany the patient(s) to a hospital following an on-scene intervention.

RECOMMENDATION

As recommended by the Council on Scientific Affairs, the AMA House of Delegates adopted the following modification of AMA policy at the 2005 AMA Annual Meeting:

AMA Policy H-130.989, Protocol for Emergency Medical Services (EMS) Personnel and the Bystander Physician

Where there is no conflict with state or local jurisdiction protocol, policy, or regulation on this topic, the AMA supports the following basic guidelines to apply in those instances where a bystander physician happens upon the scene of an emergency and desires to assist and render medical assistance.  For the purpose of this policy, “bystander physicians” shall refer to those physicians rendering assistance voluntarily, in the absence of pre-existing patient-physician relationships, to those in need of medical assistance, in a service area in which the physician would not ordinarily respond to requests for emergency assistance.

1. Bystander physicians should recognize that prehospital EMS systems operate under the authority and direction of a licensed EMS physician, who has both ultimate medical and legal responsibility for the system.
2. A reasonable policy should be established whereby a bystander physician may assist in an emergency situation, while working within area-wide EMS protocols. Since EMS providers (non-physicians) are responsible for the patient, bystander physicians should work collaboratively, and not attempt to wrest control of the situation from EMS providers.
3. It is the obligation of the bystander physician to provide reasonable self-identification.
4. Where voice communication with the medical oversight facility is available, and the EMS provider and the bystander physician are collaborating to provide care on the scene, both should interact with the local medical oversight authority, where practicable.
5. Where voice communication is not available, the bystander physician may sign appropriate documentation indicating that she/he will take responsibility for the patient(s), including provision of care during transportation to a medical facility. (Medical oversight systems lacking voice communication capability should consider the addition of such communication linkages to further strengthen their potential in this area.)
6. The bystander physician should avoid involvement in resuscitative measures that exceed his or her level of training or experience.
7. Except in extraordinary circumstances or where requested by the EMS providers, the bystander physician should refrain from providing medical oversight of EMS that results in deviation from existing EMS protocols and standing orders.

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