Prehospital Care - Emergency Medical Services
Emergency Medical Services (EMS) are integral to the provision of emergency medical care with the Emergency Department as the primary interface between the EMS system and hospital care system. The MGH Department of Emergency Medicine is committed to supporting the highest quality EMS care through direct medical oversight of EMS systems, as well as education, research and advocacy in EMS.
Emergency Medical Services (EMS) are integral to the provision of emergency medical care. Modern EMS systems provide a wide range of services, including 911 emergency care to transport patients from the field to the Emergency Department (ED), basic and advanced life support (BLS and ALS) interfacility transport to transport patients between healthcare facilities, critical care transport to transport the most critically ill patients between healthcare facilities, and aeromedical systems whose special speed and range capabilities provide unique benefits in patient care. The integration of EMS systems with hospital care needs to be seamless in order to deliver the best patient care. The ED is the primary interface between the EMS system and hospital care system, coordinating medical control, troubleshooting problems that may occur, assuring compliance with the State regulations and providing integrated care for patients. The MGH Department of Emergency Medicine is committed to supporting the highest quality EMS care through direct medical oversight of EMS systems, as well as education, research and advocacy in EMS.
Resident physicians specializing in Emergency Medicine need a strong foundation in the understanding of EMS systems, since these services significantly impact their current and future day to day practice. In the MGH and BWH-based Harvard Affiliated Emergency Medicine Residency (HAEMR), residents are educated about the scope of practice of EMS providers, differing EMS system models, on-line medical direction, and the administrative environment in which EMS systems function. First year residents have a 1 week EMS rotation which includes ride-alongs with ALS/BLS ambulances and Boston MedFlight, a day at the Boston 911 call and dispatch center, required readings of landmark articles and current controversial topics in EMS, and opportunities to attend regional and state EMS policy meetings. Third and fourth year residents provide on-line medical control to ambulance services covering nine communities and providing Interfacility transfers. At the beginning of their third year, HAEMR residents attend a 3 hour course on the basics of on-line medical control including a review of EMS protocols, legal issues, and case reviews. Throughout the four years, HAEMR residents are presented with lectures on the history and operations of EMS, disaster topics and current practice and literature. They have the opportunity to attend disaster exercises, teach paramedic classes and attend community events with EMS.
As an ever-changing field, EMS needs high-quality ongoing research to best inform practitioners in the field and in the hospital on the optimal means of delivering care to the acutely injured or ill patient. Because of the breadth of patient conditions cared for in EMS systems, there are many different opportunities to perform research in EMS. Recent and ongoing research projects in EMS at MGH include studies on airway management, ECG transmission, and interfacility transport of stroke patients after thrombolysis. Recent and ongoing research projects in EMS at MGH include studies on airway management, interfacility transport, prehospital notification for patients with acute STEMI or stroke.
Dr. Elizabeth Temin is the Director of Prehospital Care for MGH and an attending physician in the Emergency Department at MGH. She directs the EMS rotation for the HAEMR EM residents and represents MGH on the Consortium of Boston Teaching Hospitals EMS committee, the regional medical control committee and attends the state medical services committee. She is also the Medical Director for the Spaulding Rehabilitation Hospital ALS Transfer Service. She completed an EM residency at Boston Medical Center and then an EMS fellowship at Boston Medical Center and Boston EMS, along with a MPH from the Boston University School of Public Health.
Dr. Paul Biddinger has been involved in EMS since the 1980s when he initially trained as an EMT. Dr. Biddinger joined MGH as the Director of Prehospital Care in 2002 and has served as an Associate Medical Director for South Middlesex EMS and Boston Medflight. He has also served as the Medical Director of Spaulding Hospital's ALS transfer service. He has represented MGH on a variety of EMS committees in Massachusetts, and has conducted research in field EMS use of naloxone administered nasally and interpretation of 12-lead ECGs. He has authored a number of articles and book chapters on EMS topics. Dr. Biddinger currently serves as the hospital's Associate Director of Prehospital Care.
Dr. Alasdair Conn is currently the Chief of Emergency Medicine at MGH and the Chairman of the Board of Directors of Boston MedFlight, He has served as the Medical Director for Boston MedFlight, for the State of Maryland and the Maryland State Police Aviation Division. He has also served as the Trauma Director for the Office of Emergency Medical Services in the Massachusetts Department of Public Health, Dr Conn currently sits on the Region IV EMS council Board of Directors, the Commission of Accreditation of Medical Transport Systems Board of Directors, the Paramedic Program Advisory Committee at the Northeastern University Paramedic Program and the American College of Surgeons Subcommittee on Emergency Services.