Medical Direction Toolkit (2021)

EMSC National Resource Center

Best Practices: A Guide for State Partnership Grantees on the Implementation of EMSC Performance Measures

This NRC downloadable document contains additional information regarding the EMSC State Partnership performance measures, and includes best practices from state activities related to on- and off-line pediatric medical direction. (June 2009) EMSC State Partnership Performance Measures To measure the effectiveness of federal grant programs, the Health Resources and Services Administration (HRSA) requires grantees to report on specific performance measures related to their grant funded activities. The measures are part of the Government Performance Results Act (GPRA). EMSC performance measures (PM) address operational capacity to provide pediatric emergency care, including the percent of prehospital provider agencies in the state/territory that have on- and/or off-line pediatric medical direction available from dispatch through patient to a definitive care facility (see PMs 71 and 72) . (Accessed November 2013).

American College of Emergency Physicians

Direction of Prehospital Care at the Scene of Medical Emergencies

This American College of Emergency Physicians (ACEP) policy statement asserts that the direction of prehospital care at the scene of a medical emergency should be the responsibility of the individual in attendance who is most appropriately trained and knowledgeable in providing prehospital emergency stabilization and transport. (April 2008)

Interfacility Transportation of the Critical Care Patient and Its Medical Direction

This ACEP document affirms that a patient’s condition and the potential for complications should dictate the level of services available during interfacility transportation. It further clarifies that transportation agency physician medical directors must have sufficient education, experience, and training in the management of critical care patients and in transportation medicine issues to ensure appropriate medical oversight and direction to the transportation or EMS agency and its personnel. (September 2005)

Medical Direction for Staffing an Ambulance

This policy statement states the ACEP belief that the staffing of ambulances and other out-of-hospital emergency service vehicles should be subject to local EMS system physician medical direction. (Reaffirmed April 2012)

Medical Direction of Emergency Medical Services

All aspects of the organization and provision of basic (including first responder) and advanced life support emergency medical services require the active involvement and participation of physicians. In this statement, ACEP asserts that EMS agencies must have an identifiable physician medical director at the local, regional, and state level. (April 2005)

Physician Medical Direction of EMS Education Programs

A joint policy statement between the College’s EMS Committee and the National Association of EMS Physicians’ Standards and Practice Committee, this paper discusses the role of the EMS education program medical director. It addresses this individual’s desirable qualifications, authority, and responsibility over all medical content related to patient care in EMS courses. (January 1997)

Role of Emergency Physicians in Emergency Medical Services for Children

ACEP here affirms that emergency physicians, as leaders in EMS, have a pivotal role in the integration of emergency medical services for children. They can achieve this goal, in part, by providing leadership in local, regional, and state EMS and EMSC systems through their involvement in the provision of medical direction, provider education, quality improvement, and legislative advocacy. (October 2006)

Critical Illness and Trauma Foundation

Guide for Preparing Medical Directors

This course is an entry level orientation for medical directors covering the essentials for emergency medical services (EMS) oversight and direction. These materials were adapted from the National Highway Traffic Safety Administration’s (NHTSA) Guide for Preparing Medical Directors developed originally by NAEMSP and ACEP. Although designed to serve as an orientation for rural EMS medical directors, this course may also be beneficial to the medical director of EMS in a suburban or urban area who has not taken a medical directors course. (Accessed November 2013)

Federal Emergency Management Administration

HANDBOOK FOR EMS MEDICAL DIRECTORS

Medical directors provide critical oversight and medical direction to ensure that effective emergency medical care is provided to millions of patients throughout the U.S. In addition to providing medical oversight and direction, EMS medical directors support EMS personnel and first responders through training, protocol development, and resource deployment advice. This handbook provides a baseline overview of key roles and responsibilities to assist current and prospective medical directors in performing their important missions. (March 2012)

National Association of EMS Physicians

Medical Director of Air Medical Transport Programs

This National Association of EMS Physicians (NAEMSP) paper affirms the multifaceted and integral position of a medical director for both air medical transport programs and the EMS community at large. It also discusses guidelines for medical director education, performance, and experience to ensure patient care quality, safety, and cost-effectiveness. (December 2002)

Medical Control of Emergency Medical Services (Hindmand, R. & Maggiore, W., 2011)

NAEMSP highlights this article in the Journal of Health and Life Sciences Law, page 65. The authors provide an overview of the legal issues that may arise in the relationship between EMS medical directors and the EMTs providing care under their supervision, the legal structure of medical direction within the EMS systems, and the qualifications and responsibilities of EMS medical directors. (February 2011)

National Association of State EMS Officials

The Role of State Medical Direction in the Comprehensive Emergency Medical Services System

A joint endeavor from NASEMSD, NAEMSP, and ACEP, this document endorses the belief that physician medical directors at the state level are essential components of EMS systems. The state EMS medical director is thought to provide medical aspects of leadership, oversight, coordination, access to best practices, system quality management, and research in order to assure the best possible EMS functioning for patients. (2008)

National EMS Advisory Council, Medical Oversight and Research Committee

The Next Steps for Prehospital Care Evidence-Based Guidelines

The National EMS Research Agenda, published by NHTSA in 2001, and the report on the Future of Emergency Care in the United States, published by IOM in 2006, set forth recommendations to develop evidence-based model prehospital care protocols for the treatment, triage, and transport of patients, including children. In response to these recommendations, in September 2008, the Federal Interagency Committee on EMS (FICEMS) and the National EMS Advisory Council (NEMSAC) cosponsored a national meeting, funded by NHTSA, to educate EMS leaders on the role of prehospital care evidence-based guidelines (EBGs) and to draft a National EBG Model Process (Appendix A) for the development, implementation, and evaluation of EMS guidelines.

National Highway Traffic Safety Administration

Emergency Medical Services Agenda for the Future This landmark agenda was developed to determine the most important directions for the future of EMS development. It continues to provide the guiding principles for the continued evolution of EMS, focusing on out-of-hospital aspects of the system. The Agenda describes medical direction (see page 29), the vision for the future of EMS medical direction, and the necessary actions to achieve that vision. (1995)

Evidence-Based Guidelines for Prehospital Care Since 2008, NHTSA’s Office of Emergency Medical Services and the federal EMSC Program have been fortunate to work with EMS stakeholders to create and pilot test a model for developing and implementing evidence-based guidelines (EBGs) for prehospital emergency care. In this publication, NHTSA details the progress (Appendix A) of the project with the EMS community. (January 2013)

Implementation Guide: EMS Agenda for the Future This implementation guide is designed to establish priority objectives for EMS at the local, state, and national levels. It features an objective for medical direction within emergency medical services systems, with the long-term goal being a requirement that all EMS provider agencies maintain a formal documented relationship with a qualified medical director. (1998)

North Carolina Office of EMS

North Carolina College of Emergency Physicians Standards for the Selection and Performance of EMS Medical Directors This document demonstrates state standards and performance measures for EMS physician medical directors. (2009)