Physician Response Vehicles in Emergency Medical Services Fellowships in the United States

The utilization of physician response vehicles (PRVs) in emergency medical services (EMS) in the United States (U.S.) is not well described, and previous studies have shown that EMS fellows value a PRV in their program. This study describes the function, staffing, and logistical support for PRVs affiliated with EMS fellowship programs across the U.S.

We distributed an institutional review board exempt, anonymous, 33-question REDCap online survey to all Accreditation Council on Graduate Medical Education-accredited EMS fellowship programs. The survey collected data on current and planned PRVs in EMS fellowships, including how vehicles are acquired, equipped, used, and barriers to implementation. Deidentified responses were analyzed, and descriptive statistics performed. When appropriate, Chi-square and Fischer's exact tests were used to assess statistical significance.

Ninety-two percent of existing programs responded, with 69% having PRVs and 14% in the process of obtaining them. Finances are a significant obstacle for existing (63%) and planned (70%) programs, which also (70%) worry about institutional support. Programs vary in who purchases, supplies, and maintains the PRVs. Fellows self-dispatch in 45% of programs, while in 13% they are routinely or automatically dispatched to specific calls, or when requested (18%). Fourteen provide 24/7 coverage, with a third offering twelve or fewer hours of coverage per week. Thirty-nine percent have fewer than 100 responses per vehicle, and 10% respond to over five hundred calls annually. The types of advanced procedures [most commonly thoracostomy (86%), ultrasound (86%), field amputation (76%)] performed correlate with the number of fellowship positions, equipment carried, and hours a PRV is in service. Orientation for fellows often (46%) lasts 1 to 2 months and varies in requirements. A quarter of the programs allow fellows to take the PRV home at any time. However, there is no correlation between response volume and whether fellows take the PRV home.

Most EMS fellowships have, or will soon have, PRVs, with notable differences in service hours, equipment and medications carried, procedures performed, and response volume. The use of PRVs in EMS fellowships will likely shape how PRVs are integrated into the EMS systems.