Recently, there has been a national discussion about nurse practitioners (NPs) working within emergency medical services (EMS). The National Association of EMS Physicians, the Society for Emergency Medicine Physician Assistants (SEMPA), and most recently, the American Academy of Emergency Nurse Practitioners (AAENP) have all issued position statements on this issue (AAENP, 2022; SEMPA, 2021; Wright et al., 2021). The joint mission should be centered around high-quality patient care, a multidisciplinary team, and elevating the level of NP practice available in the prehospital and interfacility settings.

NPs working in prehospital roles can add value to rural, suburban, and urban environments. In rural America, providing adequate EMS response creates challenges for ambulance providers (National Rural Health Association, 2018). Urban EMS programs are already utilizing NPs as a potential solution to augment care delivery within the EMS system in various roles (Sanko et al., 2020). However, NPs face regulatory challenges, limiting or prohibiting more active involvement in the EMS system.

According to the American Association of Nurse Practitioners (AANP), NPs in full practice authority states are more likely to practice in rural and underserved areas (AANP, 2022). To enable NPs to contribute more to prehospital care, national health care practice models and state regulators must consider rule changes that strengthen the utilization of NPs in EMS systems. NPs with appropriate training are in an ideal space to support rural EMS systems.

In addition, there are barriers to NPs working in EMS leadership roles. One of the most significant barriers is the National Registry of Emergency Medical Technicians (NREMT, 2019) requirement that all paramedics and advanced emergency medical technicians have a physician medical director. This rule becomes problematic in some of the most rural areas of the country that struggle to find medical direction. Although medical directors trained in EMS fellowships may be ideal, the physician-only language written in NREMT's guidelines marginalizes rural health care and prevents qualified NPs from participating in certain levels of medical direction.

AAENP (2022) believes that “NPs are uniquely positioned to provide and direct care of the patient within a multidisciplinary EMS system. The AAENP supports utilization of NPs in EMS to the full extent of their licensure, education, and scope of practice based on state and agency regulations.”

—Wesley D. Davis, DNP, ENP-C, FNP-C, AGACNP-BC, CEN, FAANP, FAEN
Family and Emergency Nurse Practitioner Program Coordinator and Assistant Professor, College of Nursing
University of South Alabama
Mobile, Alabama

—Chivas Guillote, DNP, ENP, FNP, AGACNP, LP
Vice President of Clinical Services
Harris County Emergency Corps
Houston, Texas
Guest Editors

American Association of Nurse Practitioners (AANP). (2022). Issues at a glance: Full practice authority. Retrieved from https://www.aanp.org/advocacy/advocacy-resource/policy-briefs/issues-full-practice-brief National Rural Health Association. (2018). EMS services in rural America: Challenges and opportunities. Retrieved from https://www.ruralhealth.us/NRHA/media/Emerge_NRHA/Advocacy/Policy%20documents/05-11-18-NRHA-Policy-EMS.pdf Sanko S., Kashani S., Ito T., Guggenheim A., Fei S., Eckstein M. (2020). Advanced practice providers in the field: Implementation of the Los Angeles Fire Department Advanced Provider Response Unit. Prehospital Emergency Care, 24(5), 693–703. doi:10.1080/10903127.2019.1666199 Society for Emergency Medicine Physician Assistants (SEMPA). (2021). Guidelines for the emergency medical services physician assistant. Retrieved May 18, 2022, from https://www.sempa.org/globalassets/sempa/media/pdf/about-sempa/guidelines-for-the-emergency-medical-services-physician-assistant—july-2021.pdf Wright D., Baker T., Muthersbaugh H., Platt T., Kerr R., Miller J. (2021) Position statement: The role of the EMS physician assistant (PA) and nurse practitioner (NP) in EMS systems, prehospital emergency care. Prehospital Emergency Care. Advanced online publication. doi:10.1080/10903127.2021.1977878