We read with interest the article “Emergency Nursing Staff Dispatch: Sensitivity and Specificity in Detecting Prehospital Need for Physician Intervention During Ambulance Transport in Rovigo Emergency Ambulance Service, Italy” by Leopardi and Sommacampagna.Reference Leopardi and Sommacampagna 1 Regarding the Iranian EMS system; several points merit mention:
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1. Physician based EMS systems are common in Europe,Reference Miller, Eriksson, Fleisher, Wiener-Kronish and Young 2 but in Iran it is paramedic-based.
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2. Physician-based EMS has several advantages:
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a. Physicians are trained in diagnosis and treatment of complicated emergencies and can provide diagnosis and treatment at the scene; this can be life-savingReference Ravari, Abrishami, Ghezel-Sofla, Vahedian-Shahroodi and Abrishami 3
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a. Physicians are trained in diagnosis and treatment of complicated emergencies and can provide diagnosis and treatment at the scene; this can be life-savingReference Ravari, Abrishami, Ghezel-Sofla, Vahedian-Shahroodi and Abrishami 3
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b. The presence of a physician at the scene of the accident may give the families more trust and assurance
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c. Physicians can make timely decisions for complicated patient management
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d. Physicians can manage complicated CPR, intubation and patient transport to the hospital.
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e. Physicians are better able to relay the diagnosis to the hospital staff where the patient is transported.
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Physician-based EMS has several disadvantages:
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a. In many instances, the physicians are not required at the scene of the accident and the actions can be performed by a qualified nurse
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b. There are not enough physicians in Iran and traffic accidents are at an all-time high
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c. Physician salary is insufficient.
In any case, in Iran, EMS training must be repeated once every two years for nurses and doctors; assessment and resuscitation training has to be repeated and evaluated.Reference Mokhtari Nori, Saghafinia, Kalantar Motamedi and Khademol Hosseini 4
