EMT-defibrillation in rural America.

Physician assistants who work in community medicine must be aware of the need for, and limitations of, prehospital emergency care systems. In rural communities, effective emergency cardiac care systems lag behind those of urban areas: establishing and maintaining a rural paramedic-level ambulance service is expensive, and continued competency must be shown in complex skills even when the volume of emergency calls is low. Basic-level ambulance technicians can be trained in 16 hours to recognize and defibrillate patients in ventricular fibrillation, however, and automated external defibrillators that require minimal training to use may simplify effective, advanced cardiac care. Defibrillation programs require strong medical control and well-designed quality assurance mechanisms. Medical control is ultimately the responsibility of the physician-medical director, but in many small communities day-to-day tasks of medical control and quality assurance are assumed by PAs.