Role of the EMS Medical Director

Dr. Caleb Trent, Medical Director

For Lawrence-Douglas County Fire Medical and

Douglas County EMS First Responders

The general responsibilities of the medical director include the establishment and maintenance of guidelines for care. Each component of our EMS system has an important impact on patient care, and the medical director must have a working understanding of each. Dispatch, first responders, EMTs, paramedics, and ambulance transport are publicly visible components, each of which requires regular direction. Additionally, the administration, education, and quality improvement programs of the EMS system (while less visible to the general public) require active involvement.

Qualifications:

To optimize medical direction of EMS programs, the physician medical director should demonstrate the following:

1. License to practice medicine (M.D. or D.O.) with board certification in emergency medicine

2. Familiarity with the design and operation of EMS systems, particularly the system or systems in which the student will be working.

3. Education or experience in out-of-hospital emergency care and in medical direction of EMS systems.

4. Active participation in the emergency management of acutely ill and injured patients.

5. Education or experience in EMS education and methodology

6. Education or experience in mass casualty event planning / disaster medicine.

7. A working knowledge of EMS laws and regulations as well as knowledge of EMS dispatch and communications.

Expectations:

The EMS medical director physician should maintain some type of presence in the field to provide on scene medical direction, assess compliance to policy/protocols and observe the quality of patient care as well as to be a resource/teacher for prehospital personnel. The physician should also maintain current knowledge and skills appropriate for the practice of out of hospital emergency medicine. Regarding education, it is imperative the EMS agency medical director play a central role in EMS provider education and credentialing.

The medical director should be involved in the development of agency-based continuing education to assure the accuracy and validity of the program's medical content. The physician medical director should have authority over the medical content related to patient care for all courses in the EMS education program. The physician should actively participate in the medical training of prehospital providers at both a student and practitioner level by reviewing and approving all patient care practices and by assuring the appropriateness of instructors delivering medical instruction. Finally, the physician should maintain relationships within the medical community and entities with whom prehospital providers regularly interact.

Activities:

The EMS medical direction should have involvement in multiple levels of the EMS system. Below are examples of opportunities for involvement at the medical director level.

1. Communications - 911 system, medical training of dispatch, dispatch protocols, ranking of calls, quality improvement, etc.
2. Field clinical practice – retains knowledge levels appropriate for an EMS medical director and practicing Emergency Medicine Physician through continued education; maintains active clinical practice in Emergency Department setting, an active clinical practice in prehospital medicine, and provision of direct medical oversight through regular field responses in the EMS System, credentialing at a hospital personnel based upon recognized standards, skill validation and proficiency, protocols for transport and non-transport, protocols for interactions with other agencies, etc.
3. Quality - quality improvement program involvement, establishment of measurable standards that reflect the goals and expectations of the system, data collection, ensuring compliance with patient protocols, etc.
4. Education - development of agency-based continuing education to assure the accuracy and validity of the program's medical content, education of current providers, education of pre-hospital students, anticipation in endeavors which currently a patient of research methods to improve patient care, cost effectiveness and system performance, etc.
5. System operations - advocating for quality medical care and patient outcomes, accepting feedback from consumers or health care providers, collaborating with other health provider/systems to integrate care, analyzing system efficacy and cost effectiveness with respect patient outcomes, as well as collaborating with other providers and that works with regard to public health issues, etc.

EMS Agency Obligations:

The EMS program has the obligation to provide the physician medical director with the resources and authority commensurate with the responsibilities outlined above, including the following.

1. Appropriate compensation for the time required.

2. Necessary material resources and personnel support.

3. Appropriate academic appointment, if applicable.

4. Formal agreement or contract delineating the medical director's authority and responsibilities to the program and the program's obligations to the physician medical director.