Promoting Innovation in EMS

INCONSISTENT ROLES OF STATE EMS MEDICAL DIRECTORS The role of the state EMS medical director is particularly consequential. This individual can serve as a critical link between agency medical directors and the state EMS office, and ought to function as an advocate for local EMS medical directors. Despite the importance of this position, the 2011 National EMS Assessment found: (1) only 37 states had a designated State EMS Medical Director; and (2) only 80% of state EMS medical directors were board-certified in emergency medicine. Even among states where there is an officially designated position, there is still wide variation in the position’s roles and responsibilities; approximately half serve in general advisory roles while the remainder have defined roles in state law. In the past, these duties ranged from serving as a state liaison at public meetings (94%) to participating in the education of EMS administrators stroke systems, STEMI systems or statewide pediatric systems (only 6%). Over 50% of state EMS offices reported they maintained a separate director for disaster preparedness and some identified separate specialty medical direction for pediatrics, trauma, STEMI, and stroke. 107 In PIE focus groups, the state EMS medical director was often, but not always, seen as an asset, yet the position’s authority and the degree to which it was focused on promoting innovation, were often assessed to be limited. Balancing Medical Oversight against Paramedic Professionalism. There is undoubtedly a necessary and important role for the EMS physician, and for the most part, innovation is enhanced by increased medical director engagement. Yet at the same time, efforts at increasing or expanding

the role of the medical director can at times come into conflict with efforts to promote paramedicine toward a more mature profession. Perhaps there are times when EMTs and paramedics need to be able to advocate for themselves without relying on a physician intermediary. The most commonly cited comparison is nursing, where the profession has largely resisted being subordinate to medical oversight. STRATEGIES DEVELOPING AND SUPPORTING EMS MEDICAL DIRECTORS As described by the National Association of EMS Physicians, “EMS is the practice of medicine.” 108 As such, communities should endeavor to see that all care provided by EMS occurs under the meaningful oversight of physicians. To achieve this end, national EMS associations should develop programs to attract physicians to the subspecialty of EMS, while local agencies should seek to more effectively engage EMS-trained medical directors. Non-EMS trained physicians currently serving as medical directors should be provided opportunities to further their EMS-specific education and all medical directors should seek out continuing medical education specific to EMS. In addition, EMS Medical Directors should consider acquiring formal training in public health, business, policy development, information technology and leadership. EMS agencies should provide medical directors with dedicated time, sufficient resources, and well-delineated authority and responsibilities. They should be allowed and encouraged to remain clinically active, but agencies should be discouraged from adopting restrictive criteria that select or preclude applicants based upon clinical

107 “National EMS Assessment.” National Highway Traffic Safety Administration . Last modified December 2012. 108 “History.” National Association of EMS Physicians . Accessed June 28, 2017.




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