affiliation. Instead, EMS physicians should be held to high ethical standards, recusing themselves as needed to avoid conflicts of interest and maintain a patient-centered focus. EMS medical directors must also be sufficiently protected to fulfill their professional duty to serve as patient advocates. To help support the role of the EMS medical director, the EMS community should advocate for fair reimbursement for off-line oversight, online medical control, and the current and future services provided by EMS physicians including telehealth. Looking ahead, It would be valuable for state authorities or national associations to provide a framework for EMS medical direction with regards to novel EMS services such as community paramedicine and mobile integrated healthcare that often involve collaboration with non-EMS physicians. While it would not be expected for EMS medical directors to be experts in the law, they should be proficient enough to articulate to potential collaborators the laws and regulations governing EMS personnel. MAXIMIZING THE ROLE OF THE MEDICAL DIRECTOR Today it is common for EMS to interact with an array of external stakeholders and EMS physicians can be valuable assets to any EMS agency seeking to effectively partner with the rest of healthcare or to innovate through new collaborative models of care. Both the medical director and local, state and national leaders in EMS need to actively foster opportunities for such partnerships and collaborations. However, an EMS medical director cannot be successful at building external relationships if they are detached from internal agency decision- making. Successful innovation is most likely with
meaningful integration of both frontline EMS providers and a well-trained medical director into all aspects of policy development and service delivery - including operations, finance, quality assurance, training and education. The decision- making team in any EMS agency should include the Medical Director. The Medical Director in turn should maintain close contact with and seek input and buy-in from EMTs and paramedics. EMPHASIZING QUALITY & REDUCING VARIATION It is the responsibility of the medical director to ensure the EMS agency embraces continuous quality improvement and evidence-based care. While local protocols should be tailored to specific needs, the adoption of national evidence-based and consensus-based guidelines 109 and quality measures offers the best opportunity for high quality care. To achieve minimum acceptable standards of care, EMS medical directors should therefore strive to align their protocols with national best practices and evidence based guidelines and NEMSIS-compliant quality improvement reporting requirements. Any deviations should have a justification documented. Only after developing this foundation should new models be tested. These principles should be reinforced in EMS curriculum taught to EMS providers, medical students, residents and fellows. Medicine requires team-building and EMS agencies and their medical directors should be prepared to seek advice on systems improvement from individuals outside of their EMS system. Organizations with a shared out-of-hospital care mission, such as the American Heart Association, can provide valuable forums for such dialog and debate.
109 “National Model EMS Clinical Guidelines.” National Association of State EMS Offices . Last modified October 23, 2014. http://nasemso.org/Projects/ModelEMSClinicalGuidelines/documents/National-Model-EMS-Clinical-Guidelines-23Oct2014.pdf
MOUNT SINAI HEALTH SYSTEM | UNIVERSITY OF CALIFORNIA, SAN DIEGO
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