In an emergency, advanced training and equipment can make the difference between life and death. Penn Medicine Lancaster General Health (LG Health)’s new physician response vehicle brings high-tech gear and medical expertise directly to the scene, with a mission to save more patients’ lives.
Penn Med 1 is a large sport utility vehicle outfitted with the same lifesaving equipment and supplies as a medical helicopter. It also carries medical expertise: Its driver, Brendan Mulcahy, DO, PHP, is LG Health’s emergency medical services (EMS) medical director and an emergency medicine physician.
Mulcahy works in collaboration with Lancaster County EMS personnel to provide advanced therapy to patients at the scene of an emergency. Since May, he and Penn Med 1 have responded to vehicle crashes, cardiac arrests, overdoses, worksite accidents, and a serious fall.
LG Health’s Chief Physician Executive, Michael Ripchinski, MD, MBA, CPE, said Penn Med 1 reflects LG Health’s long-standing commitment to the community, and to delivering advanced care even before patients reach the hospital. The vehicle is owned and operated by LG Health and provided as a community service.
“With Penn Med 1, we are essentially bringing the care of the hospital to wherever our patients need us,” he said. “Our goal is to elevate the level of pre-hospital care that is available in Lancaster County and enhance survival and outcomes in our patients.”
Mulcahy, who joined LG Health in early 2023, is fellowship-trained in the subspecialty of emergency medical services. He serves on the faculty of the EMS Fellowship Program within the Department of Emergency Medicine at the Perelman School of Medicine of the University of Pennsylvania.
In addition to his medical training, he has been actively involved in emergency medical and fire and rescue services since age 18, first serving as a volunteer firefighter and EMT in his hometown. He currently serves in the Pennsylvania Army National Guard, as senior medical officer for the 328th Brigade Support Battalion.
Penn Med 1 takes advanced care right to the patient
Typically, when an emergency occurs, fire and rescue personnel first extricate a patient who might be trapped—for example, someone pinned under debris in a building collapse—and deliver them to on-scene EMS personnel for treatment, Mulcahy said. When Penn Med 1 is dispatched to a scene, he takes a different approach, called “physician-directed rescue.”
He works alongside EMS personnel, and they make patient care decisions together. His background and specialized training enable him to initiate treatment without first moving the patient, even if it means entering a collapsed building or other confined space.
“We have seen that taking earlier and more aggressive care right to the patient can significantly improve the outcome for that patient,” he said. “As an emergency physician trained in EMS, I can deliver many of the specialized procedures our trauma surgeons do, except in austere environments.”
For example, Mulcahy has the training to perform a field amputation or an emergency caesarean delivery when the mother’s life has been lost but the infant might still survive. Penn Med 1 carries advanced life support equipment, a hospital-grade ventilator, and a LUCAS device for mechanical chest compressions. It also carries two units of whole blood for on-scene transfusions, which are not generally available on EMS vehicles.
Additional features include a “physician bag” with chest tubes, arterial and central lines; an ultrasound unit; a safe to store controlled substances; a cardiac monitor; and equipment specially designed for pediatric patients. A pop-up white board is available when establishing incident command becomes necessary. Mulcahy has attended multiple cardiac arrests where the advanced therapies available on the vehicle, such as ultrasound, changed how providers on the scene managed the patient's care.
‘When we all work together, we save lives’
In addition to field response, Mulcahy utilizes Penn Med 1 to offer education to local police, fire, and EMS providers. While teaching about tourniquets and bleeding control, he also demonstrates the vehicle’s capabilities.
Edward T. Dickinson, MD, director of EMS Field Operations for Penn Medicine, said that while Penn Med 1 is impressive, Mulcahy’s wisdom and skills are more significant assets in an emergency than any single piece of equipment.
“The greatest benefit is having an expert set of hands, eyes, and ears to size up the scene and support the EMS team,” he said. “When you get an EMS physician on the scene, there’s nothing they can’t do to help.”
Mulcahy is trained to handle a difficult intubation or triage the wounded in a mass casualty event. But he also might encourage an exhausted paramedic to take a break or comfort a distraught team after a difficult loss.
Dickinson, who also serves as director of Penn Medicine’s new EMS fellowship, one of only a handful of such programs in the country, said Penn Med 1 is just one component of a comprehensive approach to enhancing pre-hospital care throughout the health system. How that care is delivered varies based on local geography, patient populations, and EMS resources, among other factors.
A physician response vehicle is a good fit for a community like Lancaster County, where it is often necessary to quickly access rural areas and a more dispersed population. Similar vehicles could be added elsewhere in the health system, if determined to be a valuable support to that particular community’s EMS system, he said.
“Wherever an emergency occurs, Penn Medicine EMS physicians are here to use our training and expertise to support and work collaboratively with the local EMS community,” Dickinson said. “There’s no question that when we all work together, we save lives.”