MD-1 Brings EMS Physicians to the Scene of the Emergency

The two boys wouldn’t be alive today if not for MD-1.

Dr. John Pakiela knows that in his heart. 

It’s why their faces are looking back at him each day from a photograph in his office. It’s why their story is the first one that comes to mind when he’s asked to describe how this innovative approach to emergency response is having a real and lasting impact on the communities it serves.

Pakiela is an Associate Medical Director of Mercyhealth Prehospital and Emergency Services in Rockford, Illinois. He plays a vital role in the Mercyhealth MD-1 program, which provides oversight and physician-level field support to EMS teams on critical calls.

In 2018, the two boys — ages 5 and 9 at the time — were driving with their father in his pickup truck when it was hit by a semi-truck at an intersection.

“The call came in as three critical patients,” Pakiela said during a recent phone interview. “I was the first en route and asked for the other two MD-1 vehicles to respond to the scene.”

Sadly, the boys’ father died before help could reach him. The boys lived because the MD-1 team of physicians and EMS personnel performed critical care at the scene of the crash before transporting them to the hospital.

Both boys eventually walked out of the hospital. Months later, they gathered for a reunion with the emergency responders who helped save their lives. A photo taken on that day is the one Pakiela looks at each day in his office, reminding him of why MD-1 is so important.

EVERYONE HAS THEIR ROLE

Mercyhealth’s MD-1 program began in nearby Janesville, Wisconsin, in 2013. It expanded later to Walworth County, Wisconsin, and eventually across the state line into the Rockford area. 

The premise behind this program, and others like it across the country, is that by dispatching trained emergency medicine physicians along with EMS and other first responders to the scene of emergencies, you can increase the chances of a positive outcome.

Six board-certified physicians are on the Mercyhealth MD-1 staff. Two fully equipped Chevy Suburbans and two Chevy Tahoes essentially become emergency departments on wheels.

“The truck is filled with anything I’d have in the ED to take care of a critically ill patient,” Pakiela said.

MD-1 joins the other first responders at the most severe emergencies, such as a serious car crash, a building collapse, a stabbing, a shooting or cardiac arrest. The team also provides tactical support for local police departments. 

“It’s that platinum 5 or 10 minutes at beginning of care. That’s where we’re meant to make a difference,” Pakiela said. “It takes a lot of teamwork, as well. It’s not, “The doc’s here. Move to the side.’ We don’t wear capes. Everyone has their role."

A COMMUNITY RESOURCE

The goal, Pakiela said, is to elevate the level of emergency care on every call that comes in.

It begins with teaching and training. Typically, the physicians conduct lectures and teaching sessions monthly at local fire departments. Since the pandemic arrived, training has also included video lectures accessible to the EMS teams and fire departments.

Often the greatest lessons are learned while in the field or during the debriefing that follows. Those involved explain the thought process and decision-making behind how each patient was treated. 

“My job is also to enhance their skills,” Pakiela said. “They see how a physician handles the case in the field. Then they’re more confident on their own. We want to maximize what they’re able to do through teaching and training and repetition.”

There remain relatively few MD-1 programs nationwide. Most are found in larger, more urban areas. The region that Mercyhealth serves includes small and mid-sized cities, as well as the more rural locations in between. 

Its success shows that more areas could benefit from MD-1 programs if the resources were available.

“We’ve had tremendous support from our hospital system,” Pakiela said. “We don’t charge for our services. This is considered a community resource.”

As Pakiela speaks those words, another call comes in. A barricade situation with a local SWAT team. He politely excuses himself, hangs up the phone and heads off to respond to the call.

Behind him, in his office, the photo of two boys is still there — a testament to lives already saved and to those that will be saved next.