460:
protocols are reviewed, revised, and announced every four years, and any physician who wishes a change to those protocols must provide sound reasons and present a successful argument before a committee of the DIA. The medical managers for each private carrier operate in a role approximating that of medical director, but only for that one company; their authority does not extend to other companies operating in the same community. These individuals do perform quality service functions such as chart audits and complaint investigation, but they cannot unilaterally change treatment protocols. They may provide guidance, advice, and direction to paramedics by telephone or radio, or they may attend the scene in person to provide care. The Dutch system also operates a network of four helicopters staffed by physicians for rapid response to support paramedics in the field. While many of the individuals working in the Dutch system may be occasionally described as "emergency physicians", the majority, as in the Franco-German model, are actually anesthetists.
321:
supervise clinical rotations of paramedics, and in some cases, precept their initial field practice prior to formal certification or licensing. In almost all cases, the medical director will be charged with the creation of all protocols and standing orders, and with any research that goes into their creation. The medical director will also, assisted by others, be responsible for the creation and development of the
Standards of Practice for their EMS system. Throughout the paramedic's career, the medical director will provide the mechanism for medical
341:
in guiding its future direction. In this model, the paramedic is very much seen as an "extender" of the emergency physician's reach. It is rare to see physicians in the field, unless they are precepting new paramedics or performing quality assurance activities, or are residents in emergency medicine training programs, gaining required field experience or conducting research. Medical directors and ED physicians will occasionally go into the field for large incidents, such as multi victim accidents and disasters to assume on site medical command.
410:
providing ER leadership after hours in small, rural hospitals (Australia and the U.K.), while in other locations these practitioners are actually taking night calls for group medical practices (U.K.). In some cases, the practitioner retains the ability to summon a physician to the patient when the limits of the scope of practice are reached (U.K.) while in others, the finite limits of treatment are those within that scope of practice, and no physician "back-up" is normally provided (South Africa).
193:
transportation to hospital being extremely rare. Many patients will never be transported to hospital. In the French version of this model, even the triage of incoming requests for service is physician-led, with a physician, assisted by others, interviewing the caller and determining what type of response resource, if any, will be sent. The German version of this model uses "conventional" dispatch processes, with the physician being sent to calls as requested by the
473:
419:
and will investigate practice-related complaints. In some jurisdictions, the medical director will be responsible for medical quality assurance, although there are some where this function is performed by the practitioners themselves. Finally, the medical director (or other emergency physicians) may be responsible for providing the required medical "back up" when the practitioner reaches the limit of their scope of practice.
22:
340:
and building support within the medical community for expanded scopes of practice when appropriate. Finally, medical directors will act as expert advisors to those in the EMS system administration and government administration, with respect to policies and legislation required by the EMS system, and
271:
In the Anglo-American model of care, the physician remains the leader of the care team, but paramedics function much more independently than in the Franco-German model. This has not always been the case. In the earliest days of paramedicine, paramedics were required to contact a physician for formal
155:
skills only, or to restricted ALS skills, which are defined in the "standing orders" of the medical director of each respective county. In 2003, there was a reform movement to expand the "standing competency", especially in the realm of pain treatment, by offering additional training to the level of
320:
The medical director plays a key role in the professional development of paramedics as well. In almost all cases, the medical director will have, at a minimum, input into the curriculum of paramedic training at a local level. In a great many cases, they will also teach some portions of the program,
418:
or similar environment, and usually in a one-to-one ratio with the physician. The medical director will be responsible for examination of the candidate and certification of their ability to practice safely. The medical director will have a major role in determining the permitted scope of practice,
455:
whose role is oversight and quality assurance, and who may be contacted for directions by any paramedic who has reached the limits of their scope of practice, just as in the Anglo-American model. When necessary, however, the paramedic may request a rapid response by a physician, usually by either
114:
The first model, arguably the oldest, is generally described as the Franco-German model. This model is physician-led, and those personnel who serve emergencies from ambulances are often place in minor, supporting roles. There is ample evidence indicating that at the turn of the 20th century, many
459:
In this model, which is unique, the role of the medical director is substantially different. Scope of practice and all treatment protocols are developed by the Dutch
Ambulance Institute on a national basis, and cannot be unilaterally changed at the local level by individual physicians. Scope and
192:
suggest that this attitude may be changing. In this model, long "at scene" times are common. The physician attempts to provide some or all of the intervention that is necessary in place, with transportation to hospital occurring only for those with a legitimate need of a hospital bed, and urgent
450:
The model looks very much Anglo-American on its surface; however, in most cases Dutch paramedics are for all practical purposes autonomous practitioners. The scope of practice and permissible procedures are determined at a national level by the Dutch
Ambulance Institute, and all paramedics must
409:
are almost always very senior and experienced ALS providers, and retain their ability to practice these skills. In many cases, the practice of these individuals has gone well beyond what we normally consider to be the role of traditional EMS. There are locations in which these practitioners are
276:
as they were directed by the physician, with no real understanding of the actions they were performing. Control was absolute and immediate; there were examples of paramedics being trained, but not legally permitted to perform their skills, or in other cases, they could take action only with a
150:
skills at all times when the physician with whom they work is physically present. In some cases they are restricted in action if there is no physician present, a legal position mostly claimed by the physicians' lobby. Under German law, unless an immediately life-threatening or potentially
413:
In this type of model, the role of the medical director includes the teaching of the practitioners, in both the classroom and the clinical setting. Most such training programs tend to feature very large components of hands-on clinical experience, generally conducted in the
247:
The Anglo-American model of care is largely led by the medical director. This model has evolved significantly since its origins in the late 1960s. The development of this role, the professionalization of emergency medical services, the profession of paramedic, and the
312:
In such systems, the medical director's role takes on several aspects. To begin with, the medical director is much more a leader of paramedics than of other physicians. They generally perform a leadership role among the small group of physicians tasked with providing
272:
orders for each intervention that they performed. Some specialists believed this was the only safe approach to providing care in this fashion. In some early cases, "paramedics" operated blindly, providing medications from numbered or colour-coded
1386:
van
Geloven, Anna A.W.; Luitse, Jan S.K.; Simons, Maarten P.; Volker, Beijtje S.; Verbeek, Marjos J.; Obertop, Hugo (December 2003). "Emergency medicine in the Netherlands, the necessity for changing the system: results from two questionnaires".
300:
were formalized, and physicians became more comfortable in working with this new profession; then paramedics were permitted greater degrees of independent practice. In the 21st century, most paramedics function based on complex written
373:
is predetermined for the role, and within that scope of practice all treatment decisions are made and care rendered at the discretion of the individual paramedic. In many cases, the scope of practice will focus more heavily on
159:
This model is intended to bring physician-centred definitive care to the patient, rather than bringing the patient to the care. As a result, in addition to conventional ambulances, most communities have physicians (called
451:
function within this guidance. Within the scope of practice, however, all judgment and treatment decisions fall to the paramedic, as in the
Autonomous Practitioner model. Each ambulance service is required to employ a
277:
physician or nurse present, much like the existing Franco-German model. In the earliest stages of paramedicine, the paramedics were not yet formally licensed and often served as an extension of the physician's
146:, immediate, and direct. The training of the Rettungsassistent is comparable to that of many North American paramedics, but they may be limited in their scope of practice. Paramedics may practice
456:
vehicle or helicopter. In these cases, a great deal of emergency intervention will occur on the scene, with the patient transported ultimately by land ambulance, as in the Franco-German model.
431:, which use a blend of a number of these models, including the Franco-German, Anglo-American, and Autonomous Practice models. In the Netherlands, for example, all paramedics are in fact
212:. In this model, the medical director is typically more of a leader of physicians, and an advisor on the training of, and quality control for, subordinate staff. In Germany, the term
1677:
1151:
1520:
357:
some paramedics have evolved into a role of autonomous practitioners in their own right. In such cases, individual paramedics may function in much the same manner as
332:
and reviewing medically related service complaints, and may often have the ability to de-certify individual paramedics for cause. Medical directors will also act as
1202:
94:, clinical teaching services, and others. A medical director devises the protocols and guidelines for the clinical staff and evaluates them while they are in use.
1046:
568:
paramedic training program and New
Orleans Police EMS Detail (now New Orleans EMS), inventor of the McSwain Dart (for paramedic emergency management of
1351:
Dib JE, Naderi S, Sheridan IA, Alagappan K (January 2006). "Analysis and applicability of the Dutch EMS system into countries developing EMS systems".
1670:
1284:
1258:
609:
1755:
1590:
1021:
217:
1495:
123:; physicians who responded in the ambulance and provided care in a manner which very much resembles the current Franco-German model. In the
443:
training is also acceptable, who then complete an additional year of training in ambulance care. All such individuals are licensed by the
32:
1120:
43:
1984:
1663:
835:
447:(DIA), and are employed by one of approximately 45 private companies providing emergency ambulance service under government contract.
260:
for emergency medicine. Prior to 1970, there was no concerted effort to formally train physicians in its practice in the U.S. In the
996:
955:
910:
885:
616:
61:
1158:
1979:
1524:
1615:
1259:"Competence and curriculum framework for the emergency care practitioner (Royal College of Physicians of Edinburgh website)"
309:
committed to memory, often numerous pages in length, and contact a physician only when standing orders have been exhausted.
522:– co-founder of Freedom House, one of the first EMS medical directors in America, and first formal medical director of the
1227:
1206:
808:
390:, than is normally permitted to the paramedic. In some jurisdictions, such practitioners even have the authority to both
1750:
1740:
971:
194:
1938:
1856:
1828:
1818:
1813:
1745:
1717:
602:, and founding medical director of the Freedom House Ambulance Service (America's first paramedic ambulance service).
1326:
1686:
103:
83:
292:
continues to have such a system, as of 2008. As the training, knowledge and skill level of paramedics increased,
1725:
1640:
1796:
1735:
1050:
926:
172:
in the sense that North
Americans understand it. In these cases, the "emergency physician" is most commonly an
1292:
143:
851:
440:
82:
who provides guidance and leadership on the use of medicine in a healthcare organization. These include the
1861:
555:
718:
1707:
1262:
147:
36:
that states a
Knowledge (XXG) editor's personal feelings or presents an original argument about a topic.
832:
164:) who respond directly to every life-threatening call to provide care. This system does not recognize
1823:
1786:
569:
391:
358:
185:
184:. In most areas of Europe, there appears to be little interest in developing emergency medicine as a
746:
Cooke MW, Bridge P, Wilson S (2001). "Variation in emergency ambulance dispatch in
Western Europe".
1958:
1765:
651:
599:
362:
1594:
1025:
1948:
1876:
1702:
1546:
1499:
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790:
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646:
621:
537:
165:
152:
1431:
1127:
1953:
1933:
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1907:
1848:
1404:
1368:
1102:
951:
906:
881:
782:
692:
432:
370:
337:
302:
249:
169:
1641:"Female EMS Leader Spotlight: Jullette M. Saussy, MD (Journal of Emergency Medical Services)"
1843:
1396:
1360:
1092:
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774:
684:
523:
1182:
1943:
1886:
1871:
1833:
1455:
839:
322:
278:
256:
relationship since the early years. Prior to 1979, there was no formal specialty training
1152:"Advanced Life Support Practitioner (Health Professions Council of South Africa website)"
1000:
809:"American Emergency Physicians Create Italian Emergency Medicine Program (ACEP website)"
306:
1097:
1072:
656:
518:
415:
209:
116:
1022:"Court Rules in Case of Decertified Paramedic (Cdn Union of Public Employees website)"
765:
Dick WF (2003). "Anglo-American vs. Franco-German emergency medical services system".
675:
Dick WF (2003). "Anglo-American vs. Franco-German emergency medical services system".
472:
1973:
1803:
1400:
551:
547:
297:
265:
257:
1416:
794:
704:
1912:
1866:
1730:
1697:
1364:
387:
375:
354:
1619:
131:
perform advanced care, and ambulance drivers have only minimal medical training.
1088:
633:
590:
565:
510:
428:
395:
173:
91:
1234:
719:"Ambulance Surgeon Defended by Superior (N.Y. Times article, dated 19.02.1906)"
1808:
812:
778:
688:
625:
436:
314:
235:, the position of medical director at hospitals and clinics is referred to as
1655:
1475:
975:
554:
operation in the U.S. (Maryland State Police). Creator of the concept of the
268:
in
Emergency Medicine had existed for at least two decades before that time.
1881:
1791:
1760:
366:
350:
333:
293:
282:
253:
177:
79:
1408:
1372:
1106:
833:
German Federal Board of Physicians: Guidelines for the Medical director EMS
786:
696:
228:, and it corresponds to the position of medical director in North America.
1891:
1330:
383:
379:
285:
273:
87:
1306:
612:
and a nationally recognized female leader in emergency medical services.
629:
583:
533:
289:
181:
135:
151:
debilitating emergency is present, such individuals may be limited to
329:
232:
225:
205:
201:
128:
124:
1121:"The Rural and Regional Paramedic: Moving Beyond Emergency Response"
369:, clinical judgments, and treatment decisions. In all such cases, a
1570:
579:
326:
189:
378:, although providing a more comprehensive level of care, such as
261:
221:
1659:
595:
467:
15:
1047:"About the Program (Sudbury, Ontario Base Hospital website)"
119:
hospital-based ambulances in larger centres were staffed by
997:"Standing Orders (Kingston, Ontario Base Hospital program)"
33:
personal reflection, personal essay, or argumentative essay
550:(ShockTrauma — Baltimore) and of the first dedicated
748:
The Scandinavian Journal of Trauma and Emergency Medicine
546:– founding medical director of America's first dedicated
852:"Vad är HUVUDLÄKAREN på Engelska - Engelsk Översättning"
484:
39:
1203:"Emergency Care Practitioner (staffnurse.com website)"
878:
History Of Accident And Emergency Medicine, 1948-2004
382:, or the management of long-term conditions, such as
1926:
1900:
1842:
1779:
1716:
1456:"Cobb honored of one of the 'Resuscitation Greats'"
349:In some parts of the world, most notably the U.K.,
200:The Franco-German model operates in most places in
138:version of the model, there are paramedics (called
1073:"Paramedic practitioners and emergency admissions"
950:. Sudbury, Mass: Jones & Bartlett Publishers.
435:with one year of additional training, usually in
1616:"EMS: Biographies (City of New Orleans website)"
106:(EMS) varies by which type of system is in use.
252:of emergency medicine, have all developed in a
1671:
1327:"University of Groningen Mobile Medical Team"
216:is used. This physician's role is to oversee
8:
1183:"Emergency Care Practitioners (NHS website)"
946:Victoria L. Fedor; Jacob L. Hafter (2003).
1678:
1664:
1656:
394:and dispense a limited and defined set of
365:, assessing patients and making their own
127:version of the model, only physicians and
1096:
903:Prehospital systems and medical oversight
628:EMS, substantial role in the founding of
62:Learn how and when to remove this message
1496:"Ever Ready (Tulane University website)"
1285:"EMS in the Netherlands: A Dutch Treat?"
427:There are some models, most notably the
667:
1389:European Journal of Emergency Medicine
610:New Orleans Emergency Medical Services
220:in a defined area, typically a bigger
102:The role of a medical director in the
1756:Advanced emergency medical technician
1476:"R. Adams Cowley Shock Trauma Centre"
1289:Journal of Emergency Medical Services
927:"Ambulance Act (Ontario legislation)"
7:
1545:Srikameswaran, Anita (2003-08-05).
1430:Srikameswaran, Anita (2002-12-21).
1307:"Dutch Ambulance Institute website"
905:. Dubugue, Iowa: Kendall/Hunt Pub.
564:– founding medical director of the
972:"Paramedic Protocols, Denver (Co)"
239:, literally "the head physician".
188:, although recent developments in
14:
632:, Canada, paramedic program, and
1401:10.1097/00063110-200312000-00015
540:, 'Medic One' paramedic program.
471:
214:Ärztlicher Leiter Rettungsdienst
20:
336:for their paramedics, advising
1365:10.1016/j.jemermed.2005.05.014
594:– credited as the inventor of
464:Other healthcare organizations
1:
1521:"The Founding Fathers of EMS"
1228:"Emergency Care Practitioner"
773:(1): 29–35, discussion 35-7.
683:(1): 29–35, discussion 35–7.
620:– founding medical director,
578:– founding medical director,
532:– founding medical director,
401:In such circumstances, these
1751:Emergency medical technician
1741:Emergency medical dispatcher
636:, Canada, paramedic program.
407:Emergency Care Practitioners
317:to paramedics in the field.
1939:Critical emergency medicine
1857:Kendrick extrication device
1829:Nontransporting EMS vehicle
1819:Light horse field ambulance
1746:Emergency medical responder
1283:Wulterkens D (2005-12-06).
1089:10.1136/bmj.39356.700139.BE
1071:Woollard M (October 2007).
2001:
1985:Emergency medical services
1687:Emergency medical services
1432:"Obituary: Nancy Caroline"
104:emergency medical services
98:Emergency medical services
84:emergency medical services
1726:Certified first responder
1693:
901:Kuehl, Alexander (2002).
779:10.1017/s1049023x00000650
689:10.1017/s1049023x00000650
504:Notable medical directors
445:Dutch Ambulance Institute
1736:Emergency care assistant
1980:Health care occupations
1551:Pittsburgh Post-Gazette
1547:"Obituary: Peter Safar"
1436:Pittsburgh Post-Gazette
1077:British Medical Journal
403:Paramedic Practitioners
1287:[2009-04-04].
608:– medical director of
142:). Medical control is
42:by rewriting it in an
1708:Advanced life support
1591:"Send Freedom House!"
156:"Notfallsanitaeter".
148:advanced life support
1824:Motorcycle ambulance
1787:Air medical services
1597:on September 1, 2006
1295:on February 4, 2009.
876:Guly, Henry (2005).
767:Prehosp Disaster Med
677:Prehosp Disaster Med
570:tension pneumothorax
359:Physician assistants
1959:Wilderness medicine
1766:Emergency physician
815:on January 15, 2010
652:Emergency physician
624:paramedic program,
600:Intensive Care Unit
514:of the Amen Clinics
363:Nurse Practitioners
345:Autonomous practice
140:Rettungsassistenten
110:Franco-German model
1949:Emergency medicine
1877:Spinal precautions
1703:Basic life support
1003:on October 7, 2008
838:2007-07-02 at the
726:The New York Times
647:Emergency medicine
622:Los Angeles County
586:paramedic program.
483:. You can help by
176:, or sometimes an
166:emergency medicine
153:basic life support
121:ambulance surgeons
44:encyclopedic style
31:is written like a
1967:
1966:
1954:Military medicine
1934:Aviation medicine
1918:Search and rescue
1908:Ambulance station
1083:(7626): 893–894.
978:on March 15, 2009
501:
500:
433:registered nurses
371:scope of practice
338:elected officials
250:medical specialty
208:, but not in the
170:medical specialty
72:
71:
64:
1992:
1844:Casualty lifting
1771:Medical director
1680:
1673:
1666:
1657:
1651:
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1647:
1637:
1631:
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1628:
1627:
1618:. Archived from
1612:
1606:
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1593:. Archived from
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1523:. Archived from
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1329:. Archived from
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811:. Archived from
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723:
715:
709:
708:
672:
630:Toronto, Ontario
558:for trauma care.
524:Magen David Adom
496:
493:
475:
468:
423:Crossover models
76:medical director
67:
60:
56:
53:
47:
24:
23:
16:
2000:
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1993:
1991:
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1963:
1944:Diving medicine
1922:
1896:
1887:Vacuum mattress
1872:Scoop stretcher
1846:
1838:
1834:Water ambulance
1814:Combination car
1775:
1712:
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1571:"Freedom House"
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1333:on June 1, 2008
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1053:on May 13, 2008
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948:EMS and the Law
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840:Wayback Machine
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764:
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731:
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674:
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669:
665:
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606:Jullette Saussy
506:
497:
491:
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481:needs expansion
466:
453:medical manager
425:
347:
323:quality control
307:standing orders
279:medical license
245:
112:
100:
68:
57:
51:
48:
40:help improve it
37:
25:
21:
12:
11:
5:
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1927:Related fields
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1487:
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1422:
1395:(4): 318–322.
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657:Emergency room
654:
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617:Ronald Stewart
613:
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587:
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562:Norman McSwain
559:
544:R Adams Cowley
541:
527:
526:(Israeli EMS).
519:Nancy Caroline
515:
505:
502:
499:
498:
492:September 2018
478:
476:
465:
462:
424:
421:
416:emergency room
346:
343:
244:
243:Anglo-American
241:
210:United Kingdom
195:EMS dispatcher
117:North American
111:
108:
99:
96:
70:
69:
52:September 2018
28:
26:
19:
13:
10:
9:
6:
4:
3:
2:
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1804:Ambulance bus
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1622:on 2008-04-07
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1596:
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1552:
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1538:
1527:on 2009-03-24
1526:
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1502:on 2008-09-24
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1294:
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1279:
1276:
1265:on 2011-05-25
1264:
1260:
1254:
1251:
1240:on 2007-02-02
1236:
1229:
1223:
1220:
1209:on 2010-10-07
1208:
1204:
1198:
1195:
1184:
1178:
1175:
1164:on 2007-07-27
1160:
1153:
1147:
1144:
1133:on 2008-07-18
1129:
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1116:
1113:
1108:
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1078:
1074:
1067:
1064:
1052:
1048:
1042:
1039:
1028:on 2011-07-06
1027:
1023:
1017:
1014:
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957:0-7637-2068-2
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928:
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912:0-7872-7071-7
908:
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887:1-4039-4715-5
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581:
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560:
557:
553:
552:air ambulance
549:
548:trauma centre
545:
542:
539:
535:
531:
528:
525:
521:
520:
516:
513:
512:
508:
507:
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495:
486:
482:
479:This section
477:
474:
470:
469:
463:
461:
457:
454:
448:
446:
442:
441:critical care
438:
434:
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324:
318:
316:
310:
308:
304:
299:
298:certification
295:
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287:
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269:
267:
266:consultancies
263:
259:
258:certification
255:
251:
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218:EMS personnel
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90:departments,
89:
85:
81:
77:
66:
63:
55:
45:
41:
35:
34:
29:This article
27:
18:
17:
1913:Rescue squad
1867:Spinal board
1770:
1731:Combat medic
1698:Paramedicine
1644:. Retrieved
1635:
1624:. Retrieved
1620:the original
1610:
1599:. Retrieved
1595:the original
1585:
1574:. Retrieved
1565:
1554:. Retrieved
1550:
1540:
1529:. Retrieved
1525:the original
1515:
1504:. Retrieved
1500:the original
1490:
1479:. Retrieved
1470:
1459:. Retrieved
1450:
1439:. Retrieved
1435:
1425:
1392:
1388:
1381:
1359:(1): 111–5.
1356:
1352:
1346:
1335:. Retrieved
1331:the original
1321:
1310:. Retrieved
1301:
1293:the original
1288:
1278:
1267:. Retrieved
1263:the original
1253:
1242:. Retrieved
1235:the original
1222:
1211:. Retrieved
1207:the original
1197:
1186:. Retrieved
1177:
1166:. Retrieved
1159:the original
1146:
1135:. Retrieved
1128:the original
1115:
1080:
1076:
1066:
1055:. Retrieved
1051:the original
1041:
1030:. Retrieved
1026:the original
1016:
1005:. Retrieved
1001:the original
991:
980:. Retrieved
976:the original
966:
947:
941:
930:. Retrieved
921:
902:
896:
880:. Palgrave.
877:
871:
860:. Retrieved
858:(in Swedish)
855:
846:
828:
817:. Retrieved
813:the original
803:
770:
766:
760:
751:
747:
741:
730:. Retrieved
728:. 1906-02-19
725:
713:
680:
676:
670:
615:
605:
589:
576:Eugene Nagel
575:
561:
543:
530:Leonard Cobb
529:
517:
509:
489:
485:adding to it
480:
458:
452:
449:
444:
426:
412:
406:
402:
400:
388:hypertension
376:primary care
355:South Africa
348:
319:
311:
270:
246:
237:Huvudläkaren
236:
230:
213:
199:
161:
158:
139:
133:
120:
113:
101:
75:
73:
58:
49:
30:
1353:J Emerg Med
754:(2): 57–66.
634:Nova Scotia
591:Peter Safar
566:New Orleans
556:Golden Hour
511:Daniel Amen
429:Netherlands
396:medications
174:anesthetist
92:blood banks
1974:Categories
1809:Blood bike
1646:2010-03-17
1626:2010-03-17
1601:2007-06-26
1576:2008-11-07
1556:2008-11-28
1531:2008-12-02
1506:2008-11-28
1481:2008-11-28
1461:2008-12-02
1441:2008-11-28
1337:2008-09-22
1312:2008-11-28
1269:2008-11-28
1244:2008-11-28
1213:2008-11-28
1188:2008-11-28
1168:2008-11-26
1137:2008-11-12
1057:2008-11-26
1032:2008-11-26
1007:2008-11-26
982:2008-11-10
932:2008-11-26
862:2024-01-08
819:2008-11-25
732:2008-11-26
663:References
626:Pittsburgh
538:Washington
439:but other
437:anesthesia
315:delegation
1882:Stretcher
1792:Ambulance
1761:Paramedic
392:prescribe
367:diagnoses
351:Australia
334:advocates
303:protocols
294:licensing
264:, formal
254:symbiotic
186:specialty
178:internist
80:physician
1892:Weevac 6
1849:movement
1780:Vehicles
1417:24476623
1409:14676512
1373:16434351
1107:17916812
856:tr-ex.me
836:Archived
795:31020961
787:14694898
705:31020961
697:14694898
641:See also
598:and the
384:diabetes
380:suturing
286:province
283:Canadian
274:syringes
88:hospital
1797:history
1098:2048876
584:Florida
534:Seattle
290:Ontario
182:surgeon
162:Notarzt
144:on-line
134:In the
38:Please
1862:Litter
1718:People
1415:
1407:
1371:
1105:
1095:
954:
909:
884:
793:
785:
703:
695:
330:audits
296:, and
281:. The
233:Sweden
226:county
206:Russia
202:Europe
136:German
129:nurses
125:French
1901:Other
1413:S2CID
1238:(PDF)
1231:(PDF)
1162:(PDF)
1155:(PDF)
1131:(PDF)
1124:(PDF)
791:S2CID
722:(PDF)
701:S2CID
580:Miami
327:chart
190:Italy
180:or a
168:as a
78:is a
1847:and
1405:PMID
1369:PMID
1103:PMID
952:ISBN
907:ISBN
882:ISBN
783:PMID
693:PMID
353:and
262:U.K.
222:city
204:and
1397:doi
1361:doi
1093:PMC
1085:doi
1081:335
775:doi
685:doi
596:CPR
487:.
405:or
386:or
361:or
305:or
288:of
231:In
224:or
1976::
1549:.
1434:.
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1393:10
1391:.
1367:.
1357:30
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1363::
1340:.
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1247:.
1216:.
1191:.
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1109:.
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1060:.
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960:.
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494:)
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59:(
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