Anesthesiologists on ambulances: where do we stand?

PURPOSE OF REVIEW: This manuscript provides a critical review of the literature regarding the staffing of emergency medical services, with particular emphasis on anesthesiologists.

RECENT FINDINGS: Significant anesthesiology contributions to prehospital care include introduction of new airway management tools and improved physiological monitoring. Contributions to quality of care include patient benefit in terms of life years gained and a specific reduction in mortality from acute myocardial infarction. Intuitive concepts regarding the advantage of anesthesiologists in intubation mishaps and management of the failed airway have yet to be proven. Personnel limitations may be regional, necessitating local evaluation of anesthesiologist availability to staff ambulances. Since a major part of cost-effectiveness research is performed in the US where only paramedics staff ambulances, insufficient data exist regarding the financial implications of such practice. Burnout may be an important factor for deciding whether anesthesiologists should work in the operating room or ambulances or on an alternate basis.

SUMMARY: Further research should be performed to evaluate the clinical and financial implications of staffing ambulances with anesthesiologists or other physicians. Randomized controlled studies using standardized intubation techniques are necessary to examine whether prehospital airway management is improved when delivered by anesthesiologists.