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Physician In-field Observation of Prehospital Advanced Life Support Personnel: A Statewide Evaluation

Published online by Cambridge University Press:  28 June 2012

Daniel W. Spaite ,
Terence D. Valenzuela  and
Harvey W. Meislin
Daniel W. Spaite*
Affiliation:
Arizona Emergency Medicine Research Center, College of Medicine, University of Arizona, Tucson, Ariz.
Terence D. Valenzuela
Affiliation:
Arizona Emergency Medicine Research Center, College of Medicine, University of Arizona, Tucson, Ariz.
Harvey W. Meislin
Affiliation:
Arizona Emergency Medicine Research Center, College of Medicine, University of Arizona, Tucson, Ariz.
*
1501 N. Campbell Ave., Tucson, AZ, 85724USA
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Abstract

Study Hypothesis:

Direct physician observation of advanced life support (ALS) personnel is rare in a demographically diverse state.

Study Population:

Twenty ALS agencies from throughout Arizona.

Methods:

A board-certified emergency physician performed on-site interviews with the emergency medical services (EMS) supervisor of each agency to approximate the number of days per year that physicians observe ALS personnel in the field.

Results:

Only 11 agencies (55%) reported that physicians ever observed ALS personnel. Among all agencies, an estimated total of 84 observer-days occurred per year. The agencies staffed a total of 86 ALS units, resulting in an estimated 0.98 observer-days/unit/year (84/86). On the average, it took 3.4 ALS personnel to staff a given unit over time and the probability that an ALS provider would be on a unit on any given day was 0.29 (1/3.4). The probability of a given provider being observed during one year was approximately 0.29 (0.98 x 0.29). Thus, on the average, an ALS provider would be observed by a physician approximately once every 3.5 years (1/0.29). Among urban agencies, the “average” ALS provider would be observed once every 2.9 years. This compared to a likelihood of in-field observation of only once every 6.7 years for non-urban providers (p = .036).

Conclusions:

The skills of ALS providers in Arizona are observed by a physician in the field very infrequently. Although an uncommon occurrence in urban agencies, observation of non-urban ALS personnel occurs even less frequently. In addition, nearly one-half of the agencies surveyed never had a physician-observer. Although a variety of skills evaluation methods exist, it remains unclear whether any method is as useful as direct observation. Future investigations are needed to evaluate whether in-field physician observation impacts skills, patient care, or outcome in EMS systems.

Keywords

advanced life supportEMS physicianEMS systemsperformance evaluationnon-urbanphysician observerurban
Type
Original Research
Information
Prehospital and Disaster Medicine , Volume 8 , Issue 4 , December 1993 , pp. 299 - 302
Copyright
Copyright © World Association for Disaster and Emergency Medicine 1993

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