Physician field response: a national survey

To assess the availability, scope of practice, and training of physician field response (PFR) units for emergency medical services (EMS) systems in the United States.

The physician medical directors of EMS systems in the 125 most populous U.S. cities were surveyed by mail, with a second mailing and phone follow-up to nonresponders. In cities that listed multiple services, a survey was sent to each.

One hundred sixty-eight surveys were mailed, and 121 responses were received (72%), representing 109 of the 125 cities (87%). Seventy-seven cities (71%) reported having no PFR capability. Of the 32 (29%) with some type of PFR, two reported having a dedicated field response unit, while 30 had an "on-call" system from the hospital or home. Staffing patterns were highly variable, with no dominant pattern. The number of annual PFR responses ranged from 0 to 10,000 (median 15, IQR 3-200). All systems reported that their PFR unit was well accepted by EMS providers. The following scope-of-practice items were reported (n = 30): physician triage, 30 teams (94%); on-scene medical direction, 14 (47%); amputation, six (20%); tube thoracostomy, 12 (40%); and blood administration, 29 (97%). The following training requirements for physician team members were reported (n = 32): incident command system, 15 (47%); emergency vehicle operations, 12 (38%); hazardous materials, 13 (41%); vehicle rescue/extrication, seven (22%); confined space medicine, four (13%); and none 12 (38%).

There is a wide variability in the availability, training, and scope of practice of PFR units across the country. No standardization or trends could be detected.