Background: Prehospitalt senter at Oslo University Hospital serves a population of approximately 1.2 million and manages about 145 000 incidents per year. All registered incidents at AMK is categorized with the use of the Norwegian medical dispatch system (NMI) into one of 39 main categories, with respect to type of incident and main symptom, resulting in a recommended response priority: Red, yellow or green. Oslo is the only city in Norway with a dedicated ambulance manned with a physician, an anesthesiologist. NMI was in late 2010 adjusted in Oslo and Akershus to make recommendations for when to use the physician-manned car. The compliance with these recommendations has not been investigated. Method: We used the data files in the dispatch system (AMIS) from all ambulance missions in two weeks of September 2010 and two weeks of September 2012 and compared them with respect to the use of the physician-manned car. Only the red and yellow responses were analyzed. Results: The number of incidents with the ambulance response including the physician-manned car did not change between the two periods. The physician-manned car was assigned to <50 % of the missions where NMI recommended it as part of the response. 87 % of the missions where the physician-manned car was dispatched did not meet the criteria for recommended use of the car. Conclusion: The adjustment of NMI in Oslo and Akershus did not change the use of the physician-manned car. The use of prehospital anesthesiologist appeared to be independent of the written recommendations of use in the NMI.