J Korean Soc Emerg Med.  2021 Oct;32(5):447-460.

Clinical analysis of direct medical oversight for the national pilot program of expanding scope of firefighter emergency medical services providers in a Korean metropolitan city

• Lim JW
• Lee KW
• Kim MC

Abstract

Objective
The fire department-based emergency medical services (EMS) system and centralized direct medical oversight (DMO) system are well-established in Korea. In 2019, the government launched a national pilot program for expanding the scope of work of EMS providers. This study was undertaken to clinically examine DMO for the ‘specialized EMS squad’ in the Seoul Metropolitan City.
Methods
This is a descriptive analysis of the current status of the EMS of the city and DMO. The basic statistics of firefighter EMS providers and the DMO physicians, as well as the number of ambulance runs, were investigated during the study period (July to December 2019). Records of the DMO physicians were also reviewed, to assess intervention of the ‘specialized EMS squad’.
Results
Totally, 1,109 patients transferred to hospitals by the ‘specialized EMS squad’ were provided DMO (out-of-hospital cardiac arrest 833, chest pain 229, multiple injured trauma 21, anaphylaxis 17, unplanned out-of-hospital birth 4.; excluding 5 cases of insufficient records). In out-of-hospital cardiac arrest, intravenous epinephrine was implemented by 538 cases (64.6%). Single dose of intravenous epinephrine was used in 218 cases (40.5%), whereas two doses were administered in 163 cases (30.3%). In patients with chest pain, 12-lead electrocardiography was achieved in 226 cases (98.7%). The epinephrine autoinjector (0.3 mg) was applied for 10 cases of anaphylaxis (61.1%). Umbilical cord cutting was executed during 2 births (50%).
Conclusion
The national pilot program to expand the scope of firefighter EMS providers was successfully implemented in the Seoul Metropolitan City. Emergency physicians played critical roles for the application. The firefighter EMS providers were able to accomplish advanced life support level practices in the prehospital setting by DMO.

Keyword

Emergency medical services; Emergency medical service communication systems; Medical direction