Understanding the prehospital physician controversy. Step 1: comparing competencies of ambulance nurses and prehospital physicians.

Eur J Emerg Med. 2011 Dec;18(6):322-7.
van Schuppen H, Bierens J.


In many European countries prehospital care by emergency medical services (EMS) is supplemented by physician-staffed services. There is ongoing controversy on the benefits of a prehospital physician. Possible advantages are additional competencies of the physician. Similarities and differences in competencies of EMS providers and physicians have however never been studied. This study aims to compare competencies of ambulance nurses and helicopter EMS physicians in the Netherlands to gain better insight into the controversy of the prehospital physician.


In this descriptive study, a quantitative inventory was made of the diagnostic, therapeutic, and clinical judgment competencies of the ambulance nurse and physician, based on analysis of protocols, registration, equipment, and personal interviews.


We identified 438 mutual competencies of the ambulance nurse and physician and 62 physician-specific competencies. The ambulance nurse masters 278 diagnostic, 131 therapeutic, and 29 clinical judgment competencies. The physician masters 285 diagnostic, 175 therapeutic, and 40 clinical judgment competencies. Seventy-one percent of the physician-specific competencies are therapeutic and related to advanced life support.


The ambulance nurse and physician have various mutual competencies. In addition, the physician can provide specific competencies on the scene. Knowing the exact overlap and differences in competencies is the first step to understand the prehospital physician controversy. Our results can be used as a tool for the next step in research on prehospital care by EMS providers and physicians and to improve prehospital care.

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The start of DutchResus

This is the first blogpost on DutchResus, my blog on resuscitation, emergency anesthesia, airway management and all kinds of other related things. I’ve been thinking on starting on a blog for a long time, but never took the time. Not very surprising though, because there are other things in life that are more important, like trying to be the best husband for my wife, father of my four kids and doctor for my patients I can be. However, I couldn’t get rid of the idea. In the past years, I have learned so much through social media, it feels unfair not to try and contribute to Free Open Access Medical Education, or #FOAMed. So I will try and provide you with information to learn about resuscitation, hoping to inspire you to be the best you can.

Why the image in the header? In this blog I will focus on resuscitation and am working on PhD research on airway management and ventilation during prehospital advanced life support for out-of-hospital cardiac arrest. Why the orange colour? Orange is used often for the (H)EMS clothing in prehospital care, is the national colour for the Netherlands and I’ve got red hair which is actually orange :-).

Critical patients need high performance critical care. That is the challenge we face in resuscitation. And I believe learning is the answer to this challenge. So I hope you will learn from my blog. And I hope to learn from you.

I am planning to share some thoughts with you through blogposts, point out some recommended #FOAMed, share some of my talks and publications. Let me know what you think.


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