J Korean Soc Emerg Med.  2020 Aug;31(4):401-419.

A survey on the perception of emergency medical services (EMS) providers and medical directors toward EMS provider’s field skill proficiency

  • 1Department of Emergency Medicine, Gyeongsang National University College of Medicine and Gyeongsang National University Changwon Hospital, Changwon, Korea
  • 2Department of Emergency Medicine, Dong-A University College of Medicine and Dong-A University Hospital, Busan, Korea
  • 3Department of Emergency Medicine, Pusan National University College of Medicine and Pusan National University Yangsan Hospital, Busan, Korea
  • 4Department of Emergency Medicine, Pusan National University College of Medicine and Pusan National University Hospital, Busan, Korea
  • 5Department of Emergency Medicine, University of Ulsan College of Medicine and Ulsan University Hospital, Ulsan, Korea
  • 6Busan Metropolitan City Fire and Disaster Headquarters, Busan, 7 Ulsan Fire Department, Ulsan, Korea
  • 7Changwon Fire Department, Changwon, 9 Gyeongsangnam-do Fire Department, Changwon, Korea


This study aimed to investigate the perception of emergency medical service (EMS) providers and medical directors toward the field skill proficiency of EMS providers. We further examined differences in perception according to the certification and hospital career of individuals.
This survey was conducted enrolling all active EMS providers in Busan, Ulsan, and Gyeongnam, as well as emergency physicians who participated in direct medical direction. Pre-developed questionnaires were sent as text messages to individual EMS providers and emergency physicians using an internet-based survey tool (Google Forms). Questionnaires were composed of 25 items in 7 categories: “airway management”, “ventilatory support”, “circulatory support”, “field assessment and management of trauma patients”, “field assessment and management of patients with chest pain”, “field assessment and management of patients with neurologic symptoms”, and “other items”. The response was based on a five-point Likert scale, where 0 score indicated no experience at all.
The questionnaire was distributed to 1,781 EMS providers and 52 medical directors; of these, 1,314 (73.7%) EMS providers and 34 (65.3%) medical directors completed the survey. EMS providers rated themselves as above average (3 points) for most of the questions. However, the majority responded that they had no experience or low proficiency in endotracheal intubation and prehospital delivery (median 2; interquartile range [IQR], 0-3). Conversely, medical directors assessed the EMS provider’s proficiency as above average in use of I-gel, recognition of hypoglycemia, field management of trauma patients, use of oropharyngeal and nasopharyngeal airway, use of laryngeal mask airway, and optimal oxygen supply (median, 4; IQR, 3-4), but responded with low scores for most other questions. Based on the EMS provider certification, nurses scored themselves more proficient than level-1 emergency medical technicians (EMTs) for intravenous access (P<0.001), whereas level-1 EMTs recognized themselves more proficient than nurses for endotracheal intubation (P<0.001), use of Magill forceps (P=0.004), and pediatric cardiopulmonary resuscitation (P<0.001).
This study recognized the discrepancies in the perception of EMS provider’s field skill proficiency, as perceived by EMS providers and medical directors, and between level-1 EMTs and nurses. We propose that regional EMS authorities need to make persistent efforts to narrow these perception gaps through effective educational programs for EMS providers and medical directors.


Emergency medical technicians; Medical director; Proficiency; Emergency medical services
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