CHAPTER 7
MEDICAL DIRECTION AND OVERSIGHT
HISTORY AND CURRENT PROGRESS
Over the past two decades, various professional organizations have attempted to provide clarity on the role of the EMS medical director. 97,98,99,100 In 1996, the EMS Agenda for the Future projected that physicians would play essential new roles to advance EMS in the community healthcare system. 101 Three key strategies would be required, including: (1) building new bridges between EMS and other components of the health care system; (2) enhancing infrastructure to support streamlined public access and rapid delivery of emergency care, and (3) developing new tools and resources. EMS would need to become better integrated with hospitals, physicians, clinics, researchers, legislators, educators, finance, prevention, communication and other stakeholders. However, as was the case with many other disciplines and providers, EMS remained siloed. Recognizing the need to transform the nation’s healthcare system, Dr. Mohammad Akhter, then Executive Director of the American Public Health Association, challenged the National Association of EMS Physicians at the 2000 Annual Meeting to meet with the public health community. Quickly, the EMS and Public Health Roundtable engaged leaders in prehospital care and public health to begin this process. 102 Over the years, there emerged countless examples of exceptional EMS medical directors who expanded and transformed the role beyond what was thought to be possible. Some have served as gifted community leaders during national disasters while others have charted visionary courses to care for STEMI, stroke, cardiac arrest, trauma and pediatrics. Each success clarified and enhanced the evolving role of the EMS medical director. Following approval by the American Board of Medical Specialties in 2010, EMS became the sixth subspecialty offered to diplomates of the American Board of Emergency Medicine. The following year, the National EMS Assessment 103 determined there were nearly 21,000 licensed local EMS agencies operating in the U.S. and that 8,459 physicians served in some EMS medical director capacity. In October 2013, 203 physicians passed the first offering of the EMS subspecialty examination.
97 “Role of the State EMS Medical Director.” American College of Emergency Physicians. Last modified October 2016. https://www.acep.org/clinical---practice-management/role-of-the-state-ems-medical-director/
98 “Handbook for EMS Medical Directors.” International Association of Fire Chiefs . Accessed June 28, 2017. https://www.iafc.org/emsMedicalDirectors 99 Alonso-Serra, Hector, Donald Blanton, and Robert E. O’Connor. “Physician medical direction in EMS.” Prehospital Emergency Care 2, no. 2 (1998): 153-157.
100 “Medical Direction Toolbox.” Emergency Medical Services for Children . Accessed September 21, 2016. https://emscimprovement.center/resources/toolboxes/medical-direction-toolbox/ 101 Delbridge, Theodore R., Bob Bailey, John L. Chew, Alasdair KT Conn, Jack J. Krakeel, Dan Manz, David R. Miller et al. “EMS agenda for the future: where we are… where we want to be.” Annals of Emergency Medicine 31, no. 2 (1998): 251-263. 102 “EMS and Public Health Bulletin.” National Highway Traffic Safety Administration. Accessed June 28, 2017. https://one.nhtsa.gov/people/injury/ems/Archive/ems_publichealth/benefits.htm 103 “National EMS Assessment.” Federal Interagency Committee on Emergency Medical Services. Last modified December 20, 2011. https://www.ems.gov/pdf/2011/National_EMS_Assessment_Final_Draft_12202011.pdf
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MOUNT SINAI HEALTH SYSTEM | UNIVERSITY OF CALIFORNIA, SAN DIEGO
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