Editorial: Medical Direction is a Requirement for Con Ed Success

Medical direction has become a critical part of our modern day EMS systems as we depend on our medical directors now more than ever before. The ability to respond to the local community and treat conditions with the latest procedures, technology and a current vision are a direct reflection of the involvement of the local medical director.

The ways in which we prepare our responders to meet system requirements and clinical expectations through continuing education and training are essential elements in our EMS systems. The education models and training programs we utilize cannot be successful if the involvement from our lead physician doesn’t measure up to the expectations our unique field has grown to require. If your medical director is not sufficiently involved in your EMS system education, the message is simple—get a new medical director.

Education and training for EMS providers is delivered in a variety of methods throughout our country. While some systems provide direct delivery for their continuing education, many others rely on local community colleges or hospitals to develop and deliver the content. Regardless of the delivery mechanism, our EMS systems and medical directors should realize we own the education requirements and the associated liability, so we should own the continuing education that is provided to our field staff. Similar to physicians requiring on-the-job training and supervision of medical skills, EMS field providers also need guidance and supervision when treating patients. This guidance can be easily delivered through a continuing education program led by the local medical director.

In systems without involved medical directors education suffers, which may be evident by observing patient outcomes. Poor medical director involvement leads to EMS continuing education classes that are dull and lack substance specific to that system. Often the content in those classes is little more than a review of the material found in the initial credentialing course. Eventually, attendance in those classes may decrease because students often lack interest when they’re not being challenged and the content isn’t being delivered in a dynamic way. If you require attendance in your programs, your paramedics now become hostages to your non-productive program. Does this sound like your program? If you have a class full of providers spending class time playing games or texting on their smartphone, then this may be your program. Consider looking into your practices, utilizing training techniques to get the student involved and asking yourself where your medical director is. Your providers should be engaged in class and involved in the learning process.

Providing relevant, research-based information is the best way to achieve interest and participation. When the medical director plays an active role in the delivery of continuing education, either through training staff or by direct delivery, that level of involvement is reflected by the field staff, which is well prepared to enact the concepts and principles of the system. In this type of system the EMS field staff learns a direct message from the physician who is guiding their interventions and writing their protocols. I have witnessed firsthand that changing to active medical director involvement increases understanding in the field and allows those field providers to hear information pertinent to their system, obtaining more detailed information about why we enact certain clinical requirements.

Continuing education in an EMS system should encompass material that is significant and unique to the individual system instead of focusing solely on the textbook or the material learned in an initial credentialing course. Education and training should take place on interventions that are high-risk but low-frequency, along with meeting requirements for recertification and providing overviews of local concern. The system specific message should begin on day one of employment for the new provider and should be a theme throughout the field training process. When medical directors are involved in the lesson planning or the delivery process, our system has found the providers get more excitement from attending the continuing education session, which aids in maintaining attention and interest levels. That excitement is carried out into the field with the providers and instead of treating patients based on information they learned in class many years ago, they have been re-educated and armed with the ability to treat patients based on the most up-to-date information that is also specific to our system.

We hear from our field providers there is an increase in their comfort level, due to no longer having to wonder about clinical expectations. If a provider decides to discontinue a cardiac arrest, they have heard directly from the medical director about the expectations prior to that decision and also know exactly where to find a detailed list of the requirements within our protocol documents. The paramedics are provided the tools needed to make a sound decision for their patients, knowing they have support and without fear of repercussion from administration or a medical staff member.

Several recent publications and actions have placed an emphasis on the importance of having effective medical direction within in our EMS systems. One of the greatest accomplishments was the recent establishment of EMS as a medical subspecialty by the American Board of Medical Specialties (ABMS). Now that our profession is recognized as a subspecialty of emergency medicine, we will see even more trained EMS physicians prepared to lead our systems into the future. The National Association of Emergency Medical Technicians (NAEMT) has also weighed in on the need of physician involvement with their position statement titled “Medical Direction of Emergency Medical Services.” This document emphasizes the need of physician involvement in EMS and can be viewed at https://www.naemt.org/.

A recent publication from the Department of Homeland Security (DHS) and the U.S. Fire Administration (USFA) titled “Handbook for EMS Medical Directors” is a collaborative document that provides an overview of key roles and responsibilities within EMS systems. This is a must read for new medical directors and for any administrator who employs medical directors. This can be viewed at https://www.usfa.fema.gov/downloads/pdf/publications/handbook_for_ems_medical_directors.pdf.

As EMS continues to advance and become a welcomed member of healthcare practice, EMS systems cannot be successful in delivering excellent clinical care without a medical director who is actively involved. I have been fortunate enough to see a system go from having a long line of non-active medical directors, to a dedicated medical director who has made our trade his practice. I have seen improvement in our continuing education and training, as well as employee morale and, most importantly, patient care. All of this as a direct result of the medical director playing an active role in directing our patient care. I encourage all EMS systems to employ an EMS physician who is interested in making your service their medical practice and directing the system education and training. I encourage physicians to play an active role in EMS and understand the critical need to deliver medicine to patients in their living room. As an EMS medical director you can’t be there to treat every patient, but you can pass your knowledge and your clinical directions on to many EMS providers who will render that care to more people than one physician ever could on their own.

Joshua B. Holloman, MHS, NREMT-P, CEMSO, is chief of the EMS Division for the Johnston County EMS system in North Carolina.  Holloman teaches fire, EMS and EMD for local and surrounding communities and is an advocate for increasing education, professionalism and leadership within emergency services. Contact him at josh.holloman@johnstonnc.com