Working with your Medical Director

1. Working with your Medical Director Rick Barney MD FAAEM Director Pre-Hospital Care Beloit Memorial Hospital

2. EMS Quality • Directly correlates with: • Having a medical director • Medical Director is active • Medical Director has EMS experience • Is an Emergency Physician

3. Shortage of Good Medical Directors • It is required by administrative rule. • Many services expect this for free • Most doctors due not want responsibility • Time • Money • Legal risk • can’t always find malpractice insurance to cover EMS duties.

4. Sharing Resources is long overdue • Combining people and resources will become increasingly necessary • This should include use of shared medical director • County Medical Director • Hospital EMS Medical Director • Ad hoc sharing

5. Engage your Medical Director • Pay them something • Let them know what your expectations are • Advise them of your service goals

6. Find the person you want • Find a good medical director in your area. • Might be regional person • Ask them to be your medical director • We want to succeed • We gave these goals • We need your expertise to get there • This is what we can do for you. • Have a written contract

7. Rookie Medical Director • Part of the problem in finding someone is they do not know what to do • Arrange for a mentor • Experienced medical director • Does not have to be close

8. Ghost Medical Directors • Common problem- especially rural • Get rid of yours if you have one • Engage someone new you want and see what happens

9. Services that have no MD involvement are often dangerous

10. DUTIES of Medical Director • First-a periodic medical needs assessment of the service area • # of calls • Types of calls • # of squad members- what are they willing to learn and be responsible for? • Type of service- resources available

11. ANSWER • Level of service • Scope of practice • Training- location and cost and time • Development of Protocols • On-line medical control • Continuing assessment and education

12. Level of service • Emergency Medical Responder • EMT • Advanced EMT • Intermediate • Paramedic

13. Scope of Practice • What all is necessary • What makes sense • Scope is fairly set by administrative rule

14. Training • Often an obstacle • Too much • Too far • Too much time

15. Protocols • Get samples from services around area • Try to standardize by area • With training and oversight, get as much autonomy as possible • On-line control is often poor and unreliable

16. Oversight • Chart reviews • Squad meetings • Skills reviewed • Ride along by MD • Spending time in the ED

17. There are more and more EMS Physicians • Go to urban areas with ALS • No end in sight to rural shortage of qualified medical directors • Mandated regional approach would help • County • Hospital

18. Understand the Responsibility • Enormous • Most skills done require medical oversight • Service providers truly are extension of the Service Medical Director • Thus, MD must have total authority over medical practice of the service

19. Medical Director Course • Every Medical Director should take one • Should attend State meetings • Medical Director Meetings should be more common • Funding • Time • reimbursement

20. Review • Quality mandates medical involvement • Find the person you want • Share • Engage • Reward • Ask questions • Respect authority

21. Questions??