Working with your Medical DirectorWorking with your Medical Director

Rick Barney MD FAAEMDirector Pre-Hospital

Care Beloit Memorial Hospital

Rick Barney MD FAAEMDirector Pre-Hospital

Care Beloit Memorial Hospital

EMS QualityEMS Quality

• Directly correlates with:• Having a medical director• Medical Director is active• Medical Director has EMS experience

• Is an Emergency Physician

• Directly correlates with:• Having a medical director• Medical Director is active• Medical Director has EMS experience

• Is an Emergency Physician

Shortage of Good Medical DirectorsShortage of Good Medical Directors

• It is required by administrative rule.

• Many services expect this for free• Most doctors due not want responsibility• Time• Money• Legal risk

• can’t always find malpractice insurance to cover EMS duties.

• It is required by administrative rule.

• Many services expect this for free• Most doctors due not want responsibility• Time• Money• Legal risk

• can’t always find malpractice insurance to cover EMS duties.

Sharing Resources is long overdue

Sharing Resources is long overdue

• Combining people and resources will become increasingly necessary

• This should include use of shared medical director• County Medical Director• Hospital EMS Medical Director• Ad hoc sharing

• Combining people and resources will become increasingly necessary

• This should include use of shared medical director• County Medical Director• Hospital EMS Medical Director• Ad hoc sharing

Engage your Medical Director

Engage your Medical Director

• Pay them something• Let them know what your expectations are

• Advise them of your service goals

• Pay them something• Let them know what your expectations are

• Advise them of your service goals

Find the person you want

Find the person you want

• Find a good medical director in your area.

• Might be regional person• Ask them to be your medical director

• We want to succeed• We gave these goals• We need your expertise to get there• This is what we can do for you.• Have a written contract

• Find a good medical director in your area.

• Might be regional person• Ask them to be your medical director

• We want to succeed• We gave these goals• We need your expertise to get there• This is what we can do for you.• Have a written contract

Rookie Medical Director

Rookie Medical Director

• Part of the problem in finding someone is they do not know what to do

• Arrange for a mentor• Experienced medical director• Does not have to be close

• Part of the problem in finding someone is they do not know what to do

• Arrange for a mentor• Experienced medical director• Does not have to be close

Ghost Medical Directors

Ghost Medical Directors

• Common problem- especially rural

• Get rid of yours if you have one

• Engage someone new you want and see what happens

• Common problem- especially rural

• Get rid of yours if you have one

• Engage someone new you want and see what happens

Services that have no MD involvement

are often dangerous

Services that have no MD involvement

are often dangerous

DUTIES of Medical Director

DUTIES of Medical Director

• First-a periodic medical needs assessment of the service area• # of calls• Types of calls• # of squad members- what are they willing to learn and be responsible for?

• Type of service- resources available

• First-a periodic medical needs assessment of the service area• # of calls• Types of calls• # of squad members- what are they willing to learn and be responsible for?

• Type of service- resources available

ANSWERANSWER• Level of service• Scope of practice• Training- location and cost and time

• Development of Protocols• On-line medical control• Continuing assessment and education

• Level of service• Scope of practice• Training- location and cost and time

• Development of Protocols• On-line medical control• Continuing assessment and education

Level of serviceLevel of service

• Emergency Medical Responder• EMT• Advanced EMT• Intermediate • Paramedic

• Emergency Medical Responder• EMT• Advanced EMT• Intermediate • Paramedic

Scope of PracticeScope of Practice

• What all is necessary• What makes sense• Scope is fairly set by administrative rule

• What all is necessary• What makes sense• Scope is fairly set by administrative rule

Training Training

• Often an obstacle• Too much• Too far• Too much time

• Often an obstacle• Too much• Too far• Too much time

ProtocolsProtocols• Get samples from services around area

• Try to standardize by area• With training and oversight, get as much autonomy as possible

• On-line control is often poor and unreliable

• Get samples from services around area

• Try to standardize by area• With training and oversight, get as much autonomy as possible

• On-line control is often poor and unreliable

OversightOversight

• Chart reviews• Squad meetings• Skills reviewed• Ride along by MD• Spending time in the ED

• Chart reviews• Squad meetings• Skills reviewed• Ride along by MD• Spending time in the ED

There are more and more EMS PhysiciansThere are more and more EMS Physicians

• Go to urban areas with ALS• No end in sight to rural shortage of qualified medical directors

• Mandated regional approach would help• County• Hospital

• Go to urban areas with ALS• No end in sight to rural shortage of qualified medical directors

• Mandated regional approach would help• County• Hospital

Understand the ResponsibilityUnderstand the Responsibility

• Enormous• Most skills done require medical oversight

• Service providers truly are extension of the Service Medical Director

• Thus, MD must have total authority over medical practice of the service

• Enormous• Most skills done require medical oversight

• Service providers truly are extension of the Service Medical Director

• Thus, MD must have total authority over medical practice of the service

Medical Director Course

Medical Director Course

• Every Medical Director should take one

• Should attend State meetings• Medical Director Meetings should be more common• Funding• Time• reimbursement

• Every Medical Director should take one

• Should attend State meetings• Medical Director Meetings should be more common• Funding• Time• reimbursement

ReviewReview• Quality mandates medical involvement

• Find the person you want• Share• Engage• Reward• Ask questions• Respect authority

• Quality mandates medical involvement

• Find the person you want• Share• Engage• Reward• Ask questions• Respect authority

Questions??Questions??