Original Contribution

MD1 Response: With Physicians in the Field

Mark A. Merlin, DO, EMT-P, FACEP; Navin Ariyaprakai, MD, EMT-P, FAEMS, FACEP; Ammundeep Tagore, MD, MSHA, MBA, FAAEM, FACEP; Andrew Parrish, MD; Joslyn F. Joseph, DO, EMT; and Josephine V. Geranio, BS

12/28/2019

MD1 Response will be a recurrent update on interesting out-of-hospital cases experienced by the New Jersey statewide physician response program, MD1, and other programs around the globe. These will include cases such as prolonged entrapment, mass-casualty incidents (MCIs), and extended scenes when patients received advanced procedures or medical therapies from EMS physicians. We will explain decision-making processes and report patient outcomes whenever possible. Additionally, we would like to feature other physician response programs and support their missions.

Why is this topic important? Every EMS provider has had at least one experience when they arrived on scene to find they just couldn’t do enough to help the patient. Maybe the patient was trapped or there were too many people injured at once. While other locations, such as Paris and London, have been able to call on advanced resources for years, EMS physicians in the United States are a relatively new concept. Although locations such as Pittsburgh have utilized routine physician response, there is no standardization of physician response programs in the U.S.

Only recently has the American College of Graduate Medical Education (ACGME) accredited fellowship programs for individuals to become board-certified in emergency medical services, potentially leading to more physician response programs. As such, we hope this monthly article will be a place for us and others around the globe to review cases when an EMS physician was requested and completed an intervention. Hopefully this will be a learning experience for EMS providers regarding this new specialty and the benefits of having on location an EMS physician who has similar training and understands the benefits of being part of the out-of-hospital team.

Our Program

MD1 is a 501(c)(3) nonprofit statewide physician response program that does not charge any patient, 9-1-1 service, or healthcare system for services. The program has six physician vehicles with 15 EMS physicians. The vehicles are packed with medications, low-titer whole blood, REBOA (resuscitative endovascular balloon occlusion of the aorta) capability, bronchoscopes, various video laryngoscopy devices, amputation devices, surgical trays, pigtail catheters, chest tubes, multiple ultrasound devices, disposable transesophageal catheters, and suture kits, as well as standard equipment found on most ALS and BLS units.

MD1 can be requested by any agency, primarily for entrapments, MCIs, or any call with anticipated prolonged on-scene time. Additionally, MD1 responds to routine ALS calls to support EMS systems throughout the state.

The MD1 vehicles remain with the EMS physician 24/7. MD1 relies on donations from companies and individuals through its 501(c)(3) foundation, as well as revenue generated from various projects. All physicians have specific prehospital medical malpractice insurance that covers them for all medical procedures on the ground, in the air, and at event standbys.

Conclusion

The intention of this series is to share experiences where having the right doctor at the scene made a difference, and how physician-response programs can not just improve survival but the collaborative effort of the entire prehospital team.

Mark A. Merlin, DO, EMT-P, FACEP, is CEO of MD1, chair, NJ EMS Council, and professor of emergency medicine at Rutgers-New Jersey Medical School.

Josephine V. Geranio, BS, is administrative assistant to Dr. Merlin and the MD1 team, and continues to work in the ED. Inspired by the dedicated providers that surround her each day, Josephine aspires to become a physician and improve access to and quality of healthcare in her community.

Navin Ariyaprakai, MD, EMT-P, FAEMS, FACEP, is EMS physician for the MD1 program, program director for the EMS & Disaster Fellowship at Newark Beth Israel, and core faculty for the Emergency Medicine Residency at Newark Beth Israel .

Ammundeep Tagore, MD, MSHA, MBA, FAAEM, FACEP, specializes in emergency medicine and EMS and disaster medicine. He is associate program director of the EMS & Disaster Medicine Fellowship and core faculty of the Emergency Medicine residency at Newark Beth Israel Medical Center. His professional interests include trauma resuscitation, tactical medicine, and point of care ultrasound. Dr. Tagore is a MD1 physician for and serves as board of directors for the MD1 program.

Andrew Parrish, MD, is EMS medical director of Community Medical Center. He is originally from Orlando, Florida and graduated college from the University of Central Florida. During that time he worked on a 9-1-1 ALS unit for many years and was a lifeguard at Disney water parks during the summers. He has been in New Jersey for 8 years and completed residency at Hackensack University Medical Center. After completing residency, he remained a part of the NJ EMS fellowship as core teaching faculty.

Joslyn F. Joseph, DO, EMT, is an EMS physician from North Jersey with the MD1 program. She is founder and president of the New Jersey Chapter of NAEMSP and an emergency physician with Envision Physician Services. Her professional interests include prehospital POCUS, paramedic education, disaster medicine, and quality improvement.