1. Working with your Medical Director Rick Barney MD FAAEM Director Pre-Hospital Care Beloit Memorial Hospital Rick Barney MD FAAEM Director Pre-Hospital Care Beloit Memorial Hospital

2. EMS 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

3. Shortage 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.

4. 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

5. 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

6. 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

7. 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

8. 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

9. Services that have no MD involvement are often dangerous

10. 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

11. ANSWER 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

12. Level of service Emergency Medical Responder EMT Advanced EMT Intermediate Paramedic Emergency Medical Responder EMT Advanced EMT Intermediate Paramedic

13. Scope 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

14. Training Often an obstacle Too much Too far Too much time Often an obstacle Too much Too far Too much time

15. Protocols 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

16. Oversight 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

17. There 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

18. Understand 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

19. 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

20. Review 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

21. Questions??