Without evidence of benefit, an intervention should not be presumed to be beneficial or safe.

- Rogue Medic

Medical Oversight According to the Handbook for EMS Medical Directors – Part I

Groups of people somewhat affiliated with EMS have decided that they know how EMS medical direction should be run. Their approach would have been progressive a few decades ago, but for EMS in many places this document is a return to the Dark Ages.

The Handbook for EMS Medical Directors was developed by the International Association of Fire Chiefs (IAFC) as part of a Cooperative Agreement with the Department of Homeland Security (DHS), Federal Emergency Management Agency (FEMA), U.S. Fire Administration (USFA), and was supported by DHS, Office of Health Affairs (OHA).[1]

There are some things with which I do agree.

Physicians interested in becoming a medical director enter into an aspect of emergency medical care that is distinct from the emergency department.[1]

EMS and emergency medicine are very different.

Medical direction is essential to ensure patient care that is high quality, efficient, effective, and safe for patients as well as for providers[1]

The quality of EMS care has a lot to do with the medical director.

The American College of Emergency Physicians (ACEP) highlighted the medical director as an integral component of the EMS agency, stating that the medical director should have ultimate authority over all clinical and patient care aspects of the EMS agency[1]

That should be obvious. Is anyone else more qualified to make these decisions?

Medical oversight ensures that the care is rendered by competent medical professionals, consistent with accepted standards.[1]

But medical command permission phone call requirements assume incompetence.

As previously mentioned, the medical director needs to make every reasonable effort to know all of their providers.[1]

Absolutely. Not so much as friends, but as someone who is assessing the skills of the medics.

EMS medical direction involves granting authorities to act and accepting responsibility for the delivery of EMS patient care. Medical direction is narrower than oversight in that it defines what treatments EMS providers render when presented with medical conditions[1]

But do medical directors accept responsibility for the care provided by paramedics who should never have been authorized to provide paramedics level treatment?

Do medical directors accept enough responsibility for the care provided by paramedics who should never have been authorized to provide paramedics level treatment?

The Federal Interagency Committee on EMS (FICEMS), as well as the National Association of Emergency Medical Technicians (NAEMT), stressed the importance of medical oversight in every EMS system; equally important in day-to-day EMS operations as during catastrophic events.[1]

Medical oversight is much more important when dealing with everyday events. Catastrophic events are not common and we are not staffed to provide paramedic/ALS (Advanced Life Support) treatment on that scale.

Is this a handbook that encourages better oversight, or does this contain too much nostalgia for something that never worked?

To be continued in Part II.


[1] Handbook for EMS Medical Directors
March 2012
International Association of Fire Chiefs (IAFC) and others.
USFA page with link for download


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