The primary role of the Medical Director is to ensure quality patient care. Now what does this really mean, and how do you know what to ask when trying to determine if a medical director is a good fit? We know that finding a trusted, qualified and experienced medical director can be hard, so we’ve outlined the top 5 questions you should ask when looking for a medical director or to ask your current medical director.
Question 1 – Will your medical director be there for you when things go wrong?
By definition, health care providers and paramedics in particular will be involved in situations of illness and injury where people are hurt or may even die…if there are allegations or concerns of liability or malpractice, or whether your team performed the best they could on a hectic and dynamic call will your Medical Director standby and support you? This is a tough question to get a reliable answer to, of course if you ask them, they will say ‘Yes” but ultimately it may come down to the relationship you have with your medical director, if you have one at all, beyond just sending in a cheque.
Our best advice is get to know your Medical Director personally. Do they have a customer service approach or do you feel like you are just paying each month but don’t really get any thing more than a book of protocols and no real value? Can you pick up the phone and ask your medical director about a question that pertains to your business or a new opportunity? Will they bill you in 15 min increments for any call regardless of the subject or will they be a partner in helping you operate and grow your business?
Question 2 – Is your Medical Director also a competitor?
Many Medical Directors for paramedical and safety providers also have their own paramedics or have a financial interest in a competitor that will bid against you for contracts. This practice will not help small and medium sized companies win business and succeed. Is a competitor the right fit to help you grow your business? See question 1 above, will they be there for you when things go wrong?
Question 3 – Is your Medical Director qualified to help you succeed?
While there is no specific requirement to be a Medical Director beyond having a general medical license in your geography – typically certified specialists in Emergency Medicine are best suited to provide on line medical direction as EM specialist are trained and experienced in the interface with pre-hospital care of patients, especially those who are seriously ill or injured. A family doctor who has had an office based practice for years is probably not the best suited to help you provide the best possible care in the field for your clients. Does your Medical Director understand what it takes to be a small business owner – sure most know what how to work hard, but have they ever run a startup business?
Question 4 – Is your Medical Director really available 24/7?
In many cases, Medical Direction is provided by a single doctor who takes all of the calls all of the time. While such a person is to be commended for their dedication, busy Medical Directors can receive multiple calls at all hours of the day or night, and everyone needs a vacation at some point! A reliable Medical Direction program should have a staff of ER physicians who rotate and share on call duties to ensure that when your staff call for help, the ER doc is not on vacation or so burnt-out that he is neither supportive nor helpful.
Also, clarify the parameters for response – immediately available ER doctor on the phone, a call back within 5 min, 30 minutes or best effort, or even next business day.
Question 5 – What are you paying for and what are getting?
Remember that Medical Direction can be as simple as providing protocols for paramedics to follow or as involved as 24/7 immediately available online ER physician support. Does the cost for this service scale with the amount of business your safety or paramedic company is doing or are you paying a large flat fee even if you are small or intermittent operation? The pricing should be consistent with the amount of business your company is doing so that you can grow and succeed, especially when times are lean.
Does your medical director provide reviews and debriefs of critical incidents and near misses to be sure your company is always improving the service it provides? Does your Medical Director offer education or support for your staff? Is your medical director an educator or hold an appointment to a university or medical school?
Asking those 5 questions and truly understanding the purpose of Medical Direction and where the idea come from is critical for your future success.
The term Medical Direction arouse out of the advancement in the capability and complexity of the use of paramedics in modern EMS systems. In 1966 US President Lyndon B. Johnson received the report called Accidental Death and Disability: The Neglected Disease of Modern Society, which identified accidental injuries as the “leading cause of death in the first half of life’s span.” When evaluating prehospital emergency care, the report identified that “if seriously wounded … chances of survival would be better in the zone of combat than on the average city street.” Additionally, the report identified a lack of regulation or standards for ambulance operations or provider training. This report made several recommendations for the prevention and management of accidental injuries, including the standardization of emergency training for “rescue squad personnel, policemen, firemen and ambulance attendants.” This standardization led to the first nationally recognized curriculum for EMS—emergency medical technician–ambulance (EMT-A)—which was published in 1969. Many consider this document to be the birth of modern EMS.
Modern EMS systems are designed to bring sophisticated emergency medical care to the patient’s side in the field. While contemporary EMS systems do not routinely utilize physicians to deliver care, the public expects to receive equivalent care provided by EMS personnel. As such, EMS systems require knowledgeable physician participation and supervision at every level.
Physician Supervision in the EMS context is called Medical Direction and there are two different types of medical direction. Direct medical direction, often called On-line Medical Direction, is when care is rendered under direct orders of the base station physician, usually over the radio or telephone or increasingly using video conferencing. The other is indirect Medical Direction, or off-line medical direction, which includes the development of a set of written medical guidelines, or standing orders to guide the scope of practice of paramedics. Most systems have a blend of the two
The primary role of the Medical Director is to ensure quality patient care. Responsibilities include involvement with the ongoing design, operation, evaluation and revision of the EMS system from initial patient access to definitive patient care. In Each EMS system or company the medical director has authority over patient care, authority to limit immediately the patient care activities of those who deviate from established standards or do not meet training standards, and the responsibility and authority to develop and implement medical policies and procedures. The EMS medical director’s qualifications, responsibilities, and authority must be delineated in writing within each EMS system. Ideally, the EMS medical director will be a board-certified emergency physician.
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