Medical Direction Toolkit

ED clinicians Prehospital

Medical direction for emergency medical services (EMS) systems encompasses all aspects of physician oversight for medical care provided in the prehospital setting. Direct medical oversight, or online medical direction, involves real-time communications with EMS providers caring for a patient on an emergency scene or en route to the destination facility. Most commonly, physician medical directors (and sometimes mid-level providers, nurses, or paramedics with special training) consult with field EMS providers to direct patient care via cellular phone or two-way radio. Increasingly, video telemedicine capabilities are being incorporated into prehospital emergency care, providing opportunities for even more direct interaction between the physician medical director, EMS provider, and the patients they serve. Indirect medical direction, or offline medical direction, involves every other aspect of oversight for prehospital medical care, including development and implementation of protocols and patient care guidelines, provider training, EMS system design and evaluation, and quality assurance and improvement.

In 2006, the Institute of Medicine reported that “a lack of initial and continuing pediatric education, coupled with the low frequency with which EMT’s encounter critical pediatric patients, results in a lower level of care than should be expected of the nation’s prehospital emergency care system.” Additionally, studies have shown that prehospital providers are less comfortable with providing emergency care for pediatric patients, particularly infants. Therefore, the assurance of high quality online and offline medical direction for pediatric patients is of utmost importance.

The purpose of this toolkit is to guide EMSC program managers, physician medical directors, and EMS administrators on the roles and responsibilities of the EMS medical director and the incorporation of pediatrics into EMS medical oversight.