Technical rescue team

[bsteven2]

Does anyone have current information in regards to emergency physicians taking part in a technical rescue team, high angle rescue etc. I want to go into EM and would also like to take part in activies such as these. Would wilderness medicine include these kinds of possibilities or would a military branch be better suited. Thank you in advance for any information.

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[docB]

You can be as involved in SAR as you like. Just remember that doing that as a doc will often put you in a primarily educational/administrative role. On a scene a good medic is often just as good as a doc.

As for how to get there I suspect that most of your tech rescue training would happen seperate from your medical education.

 

[pseudoknot]

If you want to actually do high angle rescue or USAR as a hands-on team member, you will really need to be a full time firefighter who has put in the time to earn your place on the team. Being a physician is not really relevant to that kind of work. It may be possible to have some sort of oversight role on scenes like this, and maybe you could even convince someone to allow you to take part in the training, but I doubt that anyone is going to be lowering a physician down a trench on a rope when that physician spends the vast majority of his time doing completely unrelated things.

 

[docB]

It may be possible to have some sort of oversight role on scenes like this, and maybe you could even convince someone to allow you to take part in the training, but I doubt that anyone is going to be lowering a physician down a trench on a rope when that physician spends the vast majority of his time doing completely unrelated things.

I dunno. I suspect a bunch of my medic students would be happy to lower me down into a trench. Pulling me out is a different story😀.

 

[southerndoc]

Several Yale physicians are also active firefighters, and St Raph's and Yale have a joint program for physician response in the field. They're involved with technical rescues, firefighting, etc. It's possible, but not that common.

 

[bsteven2]

Directing and coordinating SAR efforts doesnt sound like a bad gig to me. I would however like some opportunities to be on the dangling end of the rope doing the hands on stuff. How to get there, im not sure. Obviously other training besides EM residency would be needed but would a fellowship in wilderness medicine be valuable in SAR etc.?

 

[pseudoknot]

Directing and coordinating SAR efforts doesnt sound like a bad gig to me. I would however like some opportunities to be on the dangling end of the rope doing the hands on stuff. How to get there, im not sure. Obviously other training besides EM residency would be needed but would a fellowship in wilderness medicine be valuable in SAR etc.?

I think that the problem is that this is not a medical domain, and so medical training doesn't confer any special qualification. MDs are able to get in to things like helicopter EMS (for better or worse) because that involves patient care. However, I'm not sure a physician would be any more able to function in technical rescue than other specialized areas of firefighting such as hazmat, swift water rescue, and so on. There are well defined pathways to these activities, but they don't have anything to do with residency or fellowships, just like there are no medical fellowships in oil painting or watch repair. Certainly some people are able to do this as part of a volunteer activity (i.e., a hobby).

 

[Dwindlin]

Before school I worked as a full time Fire/Medic, our service had FT, PT and vollys. There was a doc who was a volly who worked heavy rescue/truck co. with me but as others have said, when he was there he wasn't a doctor and did not operate as one. He was a firefighter, nothing else.

 

[Paseo Del Norte]

I do not think an EM physician would have problems hooking up with various teams or elements that specialise in rescue. Urban SAR is fairly popular right now. In my military days I had rappel master duties and we developed a custom course for the local and state law enforcement and EMS elements. It was based around rappel techniques and rope work in the urban environment, and we had a basic rescue module. Working with a stokes litter, Skedco, pickoffs, and so on. I think we may have had a SWAT physician go through. One of the courses. I also had several physicians in my CONTOMS course, back when it was still being put on. Therefore, I think it would be fairly easy to be involved; however, you as a physician would be much better in a management and medical direction role rather than working as an "operator" per se. IMHO

 

[ER-ER-Oh]

We have docs on the city's SWAT team, go with them on runs, full body armor, weapon, etc. I may be one next year. I'm also the Director of the Medical Countrol Authority for the county, part of my ED Medical Director responsibilities. I am the highest level of care during any accident/disaster/rescue, etc. if I'm on scene. I was a commercial diver for years and could do any of the rescue stuff, but the guys here are young and in shape and good at it. Sometimes the best you can do is stay out of the way of those who spend most time doing it. But I could jump in the water if I wanted to, as I've spent more time than anyone around here in dangerous, strong current, black water.

 

[pseudoknot]

We have docs on the city's SWAT team, go with them on runs, full body armor, weapon, etc. I may be one next year. I'm also the Director of the Medical Countrol Authority for the county, part of my ED Medical Director responsibilities. I am the highest level of care during any accident/disaster/rescue, etc. if I'm on scene. I was a commercial diver for years and could do any of the rescue stuff, but the guys here are young and in shape and good at it. Sometimes the best you can do is stay out of the way of those who spend most time doing it. But I could jump in the water if I wanted to, as I've spent more time than anyone around here in dangerous, strong current, black water.

Well, that's all pretty cool. To clarify, did you end up in that situation by means of an ACGME-accredited fellowship, or was it through work you did in your spare time and/or prior to med school and residency?

 

[lama]

If the military life is for you, the ultimate SAR/Operational experience is in the Air Force working with the PJ's (Pararescue). Let's just say there is no civilian equivalent even close. (Sorry SWAT guy) You will be in on covert evac missions, you will see things and go places you cant talk about and you will carry a weapon.

 

[traumasurg]

On our volly dept we have a doc that signs off on our protocols and occasionally runs with us. I do know of another local doc that runs with the FBI and she does everything they do (i.e. carry a gun, go on assaults) but as I understand the doc went through some extensive training (i.e. forced entry, marksmanship, etc.)

 

[wook]

I also had several physicians in my CONTOMS course, back when it was still being put on.

I believe they have revived the course and are expanding it with other courses.



Wook

 

[The White Coat Investor]

Agree with others that high angle rescue requires very few "doctor" skills. An EMT is probably sufficient. Paramedic might be overkill.

What you really need to know you'll probably learn from the others on the team (and from your own recreational pursuits). Most of the teams are volunteer and would love to have you. EM will be your job even though rescue might be your passion. Good luck getting an EM job near some mountains, it's tough.

And for heaven's sake, don't join the military thinking you'll get to do something cool. We're all getting out for a reason. I've gotten to "carry a weapon" and "go places I can't talk about." I've also spent months on end taking care of colds, rashes, and diarrhea while locked down on a compound in the middle east.

 

[Cmaj7th]

I'd say just eat your wheaties and join the local vollie department. at my department there are accountants, bankers, bar tenders, and school teachers etc. they all got the necessary certs though and we run pretty tight PT regimens. get in shape and your EMT (yes your EMT!) and you should be good to go.

 

[Paseo Del Norte]

I believe they have revived the course and are expanding it with other courses.



Wook

My bad, it looks like the course is still being offered,

I'd say just eat your wheaties and join the local vollie department. at my department there are accountants, bankers, bar tenders, and school teachers etc. they all got the necessary certs though and we run pretty tight PT regimens. get in shape and your EMT (yes your EMT!) and you should be good to go.

What benefit would an EM physician gain from taking an EMT-B course? Clearly, I do not really know the education an EM physician receives; however, I am not sure what EMT-B would do for the physician?

 

[docB]

What benefit would an EM physician gain from taking an EMT-B course? Clearly, I do not really know the education an EM physician receives; however, I am not sure what EMT-B would do for the physician?

Interesting question. What do EMTs know that an EP doesn't? It's actually quite a bit. Here is what I can think of off the top of my head in no particular order:

Scene size up/scene safety
Extrication
Initiating C-Spine
Driving/Apparatus Ops
Incident Command System
Rescue
Haz Mat
MCI
Radio ops
Patient handling/lifting/gurneys

 

[Paseo Del Norte]

Interesting question. What do EMTs know that an EP doesn't? It's actually quite a bit. Here is what I can think of off the top of my head in no particular order:

Scene size up/scene safety
Extrication
Initiating C-Spine
Driving/Apparatus Ops
Incident Command System
Rescue
Haz Mat
MCI
Radio ops
Patient handling/lifting/gurneys

None of this is touched on? I've seen residents riding on ambulances and just assumed EMS exposure was part of the residency experience. Thanks for the clarification.

 

[Apollyon]

Initiating C-Spine
Driving/Apparatus Ops
Incident Command System
Haz Mat
MCI
Patient handling/lifting/gurneys

Actually, between being taught in EMT class and doing EM residency, these things came to mind:

C-spine stabilization - definitely got that in residency
Driving/apparatus ops - in New York, none in EMT class; got it in EVOC and CEVO
Haz Mat - got that in residency - even have pictures of it online
MCI - got that in residency
Patient handling - got more of it in internship in NYC, specifically on how to not injure one's back - definitely more than in EMT class, where it was "lift with your legs, not your back" <-- the extent of it

 

[jbar]

Now the interesting question is if as an MD you have gone through EMT in the past, you need to keep the cert. I've let me EMT go, in part because I still know how to backboard and it seems that in most states being certified doesn't give me additional legal protection. You can't just say "oh, even though I'm licensed in this state, I'm only working at the BLS level today." Less of an issue for ALS, there isn't much that a doc can do that a medic can't in the field. But I wouldn't want to be in a lawsuit where someone says "you were on an ambulance, you could have intubated/needled the chest etc etc but you chose not to even though you knew what the patient needed because you were 'just and EMT' for the day."

 

[deleted65604]

The million dollar question... are they going to pay you as an EMT ($20/hour), or as a doctor, ($120/hour), or are you going to get paid at all.

If I could work as an EMT and get paid $120/hour, I'd quit tomorrow and sit on my arse most the day waiting for the infrequent medical call and the 1 time per year wilderness rescue.

 

[deleted65604]

None of this is touched on? I've seen residents riding on ambulances and just assumed EMS exposure was part of the residency experience. Thanks for the clarification.

EMS is a VERY low yield rotation. Sure, there are some stations that are much busier in inner cities, but most ambulance transports are insanely boring. Your role as the resident is usually to try an IV in the back of the bumpy ambulance and to get vitals.

(I never realized why they say 120/palp until the paramedic told me to get a blood pressure and laughed as I listened futilely with my stethoscope while the sirens were blaring, then laugh harder as I flailed on the IV as the bumpy ambulance careens down the road.)

On a month of EMS, I never saw a resuscitation, or a trauma scene, and other than albuterol treatments, and O2, never saw any medical treatment administered. I'm sure it is partly bad luck on my part, and other residents had more interesting rotations, but mine was BORING.

Different experiences out there?

 

[jbar]

Since a good chunk of ED patients come via ambulance, it seems that the value of the rotation is understanding what EMS has to deal with, what their capabilities are, their training, etc. Because in most places when EMS has a question or needs online medical control they get whomever is on in the ED rather than a dedicated medical director. So from that standpoint it sounds like you had a pretty useful rotation, even if you didn't get to see sick cardiac patients.

 

[docB]

None of this is touched on? I've seen residents riding on ambulances and just assumed EMS exposure was part of the residency experience. Thanks for the clarification.

Agree with Jarabacoa, most EMS rotations are really low yield. Several things contribute to this. One of the biggies is that there is a lot of reverence for doctors within EMS. Lots of EMS people assume we know everything, get intimidated and so don't want to teach the doctor and even think that the resident is there to teach and even judge them.

So EMS exposure they get. Getting taught the nuts and bolts of doing stuff prehospital, not so much.

Actually, between being taught in EMT class and doing EM residency, these things came to mind:

C-spine stabilization - definitely got that in residency
Driving/apparatus ops - in New York, none in EMT class; got it in EVOC and CEVO
Haz Mat - got that in residency - even have pictures of it online
MCI - got that in residency
Patient handling - got more of it in internship in NYC, specifically on how to not injure one's back - definitely more than in EMT class, where it was "lift with your legs, not your back" <-- the extent of it

I'm surprised you got C-spine in residency. We got tons about taking patients out of it, very little on putting people in it. Have them lay down and put a Philly collor on was about the extent. Nothing about straps, scoops, head beds, etc.

My EMT covered basic vehicle ops, driving code 3, vehicle placement on scene, etc. EVOC went on to do actual skills in an ambulance.

The HazMat I got in residency was mainly about wearing the suits and deconning incomming patients. I think we got a part of a lecture on MSDSs. There was nothing about scene size up, the rule of thumb, wind, water, passive and active transfer, etc. Based on what I learned in residency I could do the hospital end of it. I would have had no clue about getting someone to the hospital.

The MCI stuff I got in residency was similar, all on the hospital end. Everything I learned about triage tags, AVPU and ICS came from EMT (and EMS experience).

 

[Dwindlin]

Now the interesting question is if as an MD you have gone through EMT in the past, you need to keep the cert. I've let me EMT go, in part because I still know how to backboard and it seems that in most states being certified doesn't give me additional legal protection. You can't just say "oh, even though I'm licensed in this state, I'm only working at the BLS level today." Less of an issue for ALS, there isn't much that a doc can do that a medic can't in the field. But I wouldn't want to be in a lawsuit where someone says "you were on an ambulance, you could have intubated/needled the chest etc etc but you chose not to even though you knew what the patient needed because you were 'just and EMT' for the day."

I would think this is heavily dependent on state. I know in Ohio, if a physician is on scene and they want to help treat that is their legal right, however they have to assume all responsibility and accompany the patient to the ED. Now, if after med school I wanted to keep riding the truck (which I do) then it is better for me to have a EMS cert, because I am protected the same as any other medic/basic by protocol and resources.

Take this with a grain of salt however because as I said this is Ohio's system. I would contact your state EMS board to get the details.

Edit: I don't know if your in the US but if you are, the recertification test for the NREMT is pretty easy for someone who has been through med. school (as I am sure you might have guessed), so if its been less than 2 years you can re-challenge the test to get your NREMT back. Most states will re-issue you a card with NREMT (NY and CA being the exceptions I believe).

 

[JackADeli]

....I'm surprised you got C-spine (stabilization) in residency. We got tons about taking patients out of it, very little on putting people in it...

Really? I am in surgery and we got plenty of it. We also returned to it in our ATLS and other first aid disaster courses.

 

[docB]

Really? I am in surgery and we got plenty of it. We also returned to it in our ATLS and other first aid disaster courses.

You guys were taught how to put people in C-spine in cars, stairwells and other scene type settings? I'm impressed. I didn't get that in residency. I got it in EMT school.

 

[JackADeli]

You guys were taught how to put people in C-spine in cars, stairwells and other scene type settings?...

Yes. nothing impressive about it.

I never really found the topic very complicated. It was one of the simpler practices/actions we learned to perform. Actually getting emergency airways or even just field IV access in a shocky patient is IMHO more complex. C-spine? No.... Not impressed. Though, I should say some of those backboard systems seemed a little excessively complicated. I preferred the one that split down the middle. It was sort of a break-away board.

I don't remember what class/course it was.... a disaster course or emergency course or combination of courses.

 

[jbar]

Edit: I don't know if your in the US but if you are, the recertification test for the NREMT is pretty easy for someone who has been through med. school (as I am sure you might have guessed), so if its been less than 2 years you can re-challenge the test to get your NREMT back. Most states will re-issue you a card with NREMT (NY and CA being the exceptions I believe).

Things are a little complicated now, if you want to keep the cert you are supposed to be affiliated with a squad. I still ski patrol up in New Hampshire, live in CT. NREMT told me I'd have to go back up to NH and take the practical test to keep the cert. I decided that it wasn't worth the time and money to keep if since I've yet to find someone who can tell me what advantage there is to having an EMT cert once I'm an MD.

 

[docB]

Yes. nothing impressive about it.

I never really found the topic very complicated. It was one of the simpler practices/actions we learned to perform. Actually getting emergency airways or even just field IV access in a shocky patient is IMHO more complex. C-spine? No.... Not impressed. Though, I should say some of those backboard systems seemed a little excessively complicated. I preferred the one that split down the middle. It was sort of a break-away board.

I don't remember what class/course it was.... a disaster course or emergency course or combination of courses.

The split down the middle thing is called a scoop. It's not that it's really complicated however it is complex enough that you can't do it right if you've never been trained in it at all. The attitude that pervades EM and other residencies is that you either don't need to do it because it's a prehospital thing or that it's so simple that a resident should just know how to do it by instinct which is a disaster waiting to happen.

 

[Cmaj7th]

What benefit would an EM physician gain from taking an EMT-B course? Clearly, I do not really know the education an EM physician receives; however, I am not sure what EMT-B would do for the physician?

I suggested taking EMT-b because the docs on my department all have the cert and only function in that capacity. They do not provide ALS and let the medics do their thing. the medics like it because they dont feel encroached upon and I reckon the docs like it since they can still get their hands dirty without added liability. I think it works well.

 

[docB]

I suggested taking EMT-b because the docs on my department all have the cert and only function in that capacity. They do not provide ALS and let the medics do their thing. the medics like it because they dont feel encroached upon and I reckon the docs like it since they can still get their hands dirty without added liability. I think it works well.

We've had several discussions about this in the prehospital forum. Many of us are not convinced that a doc who is in a ALS environment (like an ALS ambulance) will be protected from liability by sitting back and saying "Today I'm just an EMT."

 

[Cmaj7th]

I did not know that. so if a physician is functioning under his/her liscence what limits are on their scope of practice?

 

[Paseo Del Norte]

I think realising the profound difference between a physician and a paramedic, EMT, nurse and so on will help with much of the confusion. A physician has a license to practice medicine. The scope of practice seems highly variable and much more dynamic. I remember doing a surgical rotation in nursing school with a FP physician who was also able to perform limited surgical procedures such as chole's. Therefore, the physician scope of practice is rather nebulous and physicians have the option to train and specialise in additional fields and procedures unlike the typical pre-hospital provider.

With that, while a nurse or paramedic may have a license, that license does not allow us to practice medicine. Instead, we are able to perform techniques and interventions that are dictated by a fairly rigid and well defined set of rules if you will in most cases. In addition, we provide these said modalities under the guidance and approval of a physician. We do not actually have the ability to practice medicine.

I think these concepts are what define the question at hand. We have a license to perform certain modalities under the direction of a physician where as a physician has a license to practice medicine. Therefore, having a physician work under a different set of rules is completely incompatible with their fundamental scope of practice. (medicine)

 

[jdh71]

If the military life is for you, the ultimate SAR/Operational experience is in the Air Force working with the PJ's (Pararescue). Let's just say there is no civilian equivalent even close. (Sorry SWAT guy) You will be in on covert evac missions, you will see things and go places you cant talk about and you will carry a weapon.

The air force isn't going to let an emergency trained physician carry a gun behind enemy lines doing evac. Much too valuable a commodity.

 

[Dwindlin]

The air force isn't going to let an emergency trained physician carry a gun behind enemy lines doing evac. Much too valuable a commodity.

I disagree. One of the former residents from the program here is doing just that (with the PJ's actually). Also, my current battalion chief is an ex Delta operator, and one the guys in his squad was an M.D.

Anecdotal, but that is at least 2 examples of an M.D. in a combat position.

 

[jdh71]

I disagree. One of the former residents from the program here is doing just that (with the PJ's actually). Also, my current battalion chief is an ex Delta operator, and one the guys in his squad was an M.D.

Anecdotal, but that is at least 2 examples of an M.D. in a combat position.

The military's general position since WW2 is that physicians are too valuable to be shooting and dodging bullets. I suppose no rule is good unless it has some sort of exception. I don't know what the context for having an M.D. in a Delta squad might be, though they do work unconventionally, and I can't imagine them wanting anyone who would slow them down, so I'm sure it's an extremely unique and rare situation. And as to the PJs the initial washout during the application process itself is ridiculous. I'm more than a little surprised that the AF would take a guy who has EM training and then not use him as an EP, but rather as a paramedic, but then . . . finding the right kind of 99%ile kind of guys for pararescue might make them change their mind if someone had the right physical abilities (you'd know they be able to handle the book work)

I guess my point was really that one shouldn't bank on the military allowing a physician to do some kind of snake-eater bull****. Operational medicine can get a guy close to combat, but don't count on being able to do commando stuff. Let the medics be medics. Everyone has their role, and physicians were trained to use the bells and whistles.

 

[docB]

I did not know that. so if a physician is functioning under his/her liscence what limits are on their scope of practice?

Paseo has mentioned some things about scope of practice that are true. I have found that the simplest way to avoid trouble is based on equipment. When I ride I'm a doc but I'm limited by the stuff on the rig. I can't place a central line or crack a chest because I just don't have the stuff.

 

[Dwindlin]

The military's general position since WW2 is that physicians are too valuable to be shooting and dodging bullets. I suppose no rule is good unless it has some sort of exception. I don't know what the context for having an M.D. in a Delta squad might be, though they do work unconventionally, and I can't imagine them wanting anyone who would slow them down, so I'm sure it's an extremely unique and rare situation. And as to the PJs the initial washout during the application process itself is ridiculous. I'm more than a little surprised that the AF would take a guy who has EM training and then not use him as an EP, but rather as a paramedic, but then . . . finding the right kind of 99%ile kind of guys for pararescue might make them change their mind if someone had the right physical abilities (you'd know they be able to handle the book work)

I guess my point was really that one shouldn't bank on the military allowing a physician to do some kind of snake-eater bull****. Operational medicine can get a guy close to combat, but don't count on being able to do commando stuff. Let the medics be medics. Everyone has their role, and physicians were trained to use the bells and whistles.

I actually agree with your general message, personally I would think a physician would be better utilized acting as a physician. Also, as I re-read my post the first part sounds a little snarky (the "I disagree"), its not meant to be.

Also to add something, both of these cases were guys that joined up after completing their residencies, so that probably has something to do with it I'm sure (i.e. government didn't shell out the money to train them). The one who was a Delta operator didn't perform anything more advanced than what a combat medic would have, so to my knowledge he wasn't a doc for Delta...he was simply a Delta operator.

 

[Xerxes1729]

In the West, most search and rescue is a volunteer affair. Even high-angle rescue teams, like Portland Mountain Rescue, are all-volunteer. Of course, you need to come into groups like that with significant technical skills and physical aptitude, and you have to go through a lot of training. Being a physician won't keep you out, but I doubt it's going to make up for a lack of skill or strength.

 

[deleted109597]

Don't get me wrong. I love going on tactical missions, just like I enjoy going to scenes. But to do it for a living is too risky.
Similarly, my wife gets mad at me when I work on my vehicle. I do it because I enjoy it. Sure, some are better than me. I can likely earn more per hour working as a doc than replacing an intake manifold. The likelihood of crushing my hand would be less too.
So I don't do it every day. But some days, I want to get out of the windowless prison that is the hospital. People try to take the spine board away from me as I carry them outside, but I fight them off. I want to go outside dammit.

 

[FDNewbie]

Does anyone have current information in regards to emergency physicians taking part in a technical rescue team, high angle rescue etc. I want to go into EM and would also like to take part in activies such as these. Would wilderness medicine include these kinds of possibilities or would a military branch be better suited. Thank you in advance for any information.

Came across this while searching for someone else. Thought I'd throw my $0.02 and give ya a head's up that quite a few EMS Fellowships are including dive rescue, confined space rescue, high angle rescue, USAR, etc as an integral part of their fellowship experience.

Interesting question. What do EMTs know that an EP doesn't? It's actually quite a bit. Here is what I can think of off the top of my head in no particular order:

Scene size up/scene safety
Extrication
Initiating C-Spine
Driving/Apparatus Ops
Incident Command System
Rescue
Haz Mat
MCI
Radio ops
Patient handling/lifting/gurneys

Very true. And all of those are covered formally with actual reading & extended field experience via the following Fellowship objectives:

- Assessment and care of specific pre-hospital clinical problems
- EMS system planning, design, and logistics
- Dispatch and communications
- Clinical research
- Education of EMS personnel
- Medical oversight of EMS
- Critical care transportation
- Air medical services
- Injury prevention and preventative health
- HAZMAT experience
- Disaster preparation and response

Many programs specifically have the following courses built into the Fellowship, and you can run with it as you'd like:

- EVOC
- Extrication course
- Confined space
- HAZMAT
- Technical rescue
- SWAT physician response
- Incident Command Course
- Firefighter 1

Having said that, not all EMS Fellowships are created equally. You gotta take the time to explore their websites & exchange correspondence with them to see who offers what, because there's a ton that offer a lot of this or that, but very few who have the money, location, resources, memorandums of understanding, etc to offer you the full experience (which I think is KEY, cuz at the minimum, the best medical QA & oversight comes from having hands-on knowledge & experience of what you're managing).

Well, that's all pretty cool. To clarify, did you end up in that situation by means of an ACGME-accredited fellowship, or was it through work you did in your spare time and/or prior to med school and residency?

Not to answer for him, but to date, there are no ACGME-accredited fellowships that can provide you with the above training. EMS has just become recognized as an ACGME-accredited fellowship, but the curriculum is still under development (likely a year out at this point), and after that, the exam still has to be made, then programs have to be accredited individually (and more than likely that will only happen when their EM Residency is up for review/re-accreditation). So aside from waiting for 5 or so years to jump into one of the brand new accredited EMS Fellowships, you can gain board certification through two other means:

EMS Practice Pathway:

Physicians who apply through the EMS practice pathway must demonstrate that within the six years immediately preceding the date on which they submit their EMS certification application they have completed a minimum of 60 months of EMS practice (of at least 400 hours per year) as Assistant, Associate, or Medical Director of an EMS agency with patient care responsibility or as a direct provider of prehospital emergency care.

EMS Practice-Plus-Training Pathway

Physicians who apply through the EMS practice-plus-training pathway must have:
- Successfully completed an acceptable, unaccredited fellowship in EMS, and
- Within the 6 years immediately preceding the application, completed a minimum of 24 months of EMS practice (at least 400 hours per year) as Assistant, Associate, or Medical Director of an EMS agency with patient care responsibility, or as a direct provider of pre-hospital emergency care.

More info on the eligibility requirements can be found here: http://www.abem.org/PUBLIC/_Rainbow/Documents/EMS Elig Criteria 2010.pdf