Peter Taillac MD FACEP FAEMS Medical Director Utah Bureau of EMS and Preparedness Utah Department of Health Utah State Requirements 1 The Department may certify an offline medical director for a four year period ID: 932384
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Slide1
EMS Medical Direction: “What does that doc do, anyway?”
Peter Taillac, MD, FACEP, FAEMS
Medical Director
Utah Bureau of EMS and Preparedness
Utah Department of Health
Slide2Utah State Requirements
(1) The Department may certify an off-line medical director for a four year period.
(2)
An off-line medical director must be:(a) a physician actively engaged in the provision of emergency medical care;(b) familiar with the Utah EMS Systems Act, Title 26, Chapter 8a, and applicable state rules; and(c) familiar with medical equipment and medications required under "R426 Equipment, Drugs and Supplies List."
R426-12-1200
Slide3Utah State Requirements
(1) An individual who wishes to certify as an off-line medical director must:
(a) have completed an American College of Emergency Physicians or National Association of Emergency Medical Services Physicians medical director training course or the Department's
medical director training course within twelve months of becoming a medical director;(b) submit an application and;(c) pay all applicable fees.R-426-12-1201
Slide4What he’s supposed to do:Know the system
(1) All licensees, designated dispatch centers, and quick response units must enter into a written agreement with a physician to serve as its off-line medical director to supervise the medical care or instructions provided by the field EMS personnel and dispatchers.
The physician must be familiar with
:(a) the design and operation of the local prehospital EMS system; and(b) local dispatch and communication systems and procedures.
R426-15-401
Slide5What she’s supposed to do:Protocols
(2) The off-line medical director
shall develop and implement patient care standards
which include written standing orders and triage, treatment, and transport protocols or pre-arrival instructions to be given by designated emergency medical dispatch centers.AND:(4)(b) annually review triage, treatment, and transport protocols and update them as necessary;
R426-15-401
Slide6What he’s supposed to do:Teach and evaluate medics
(3) The off-line medical director shall ensure the qualification of field EMS personnel involved in patient care and dispatch through
the provision of ongoing continuing medical education
programs and appropriate review and evaluation;R426-15-401
Slide7What she’s supposed to do:QA/QI
(4) The off-line medical director shall:
(a)
develop and implement an effective quality improvement program, including medical audit, review, and critique of patient care;R426-15-401
Slide8What he’s supposed to do:Discipline (??!!)
(c)
suspend
from patient care, pending Department review, a field EMS personnel or dispatcher who does not comply with local medical triage, treatment and transport protocols, pre-arrival instruction protocols, or who violates any of the EMS rules, or who the medical director determines is providing emergency medical service in a careless or unsafe manner. The medical director must notify the Department within one business day of the suspension.R426-15-401
Slide9What she’s supposed to do:Participate
(d
) attend meetings of the local EMS Council
, if one exists, to participate in the coordination and operations of local EMS providers.R426-15-401
Slide10What your medical director doesn’t (want to) do
Deal with labor issues
Deal with financial issues (unless medically related)
Deal with political issues (unless medically related)Deal with turf battles
Slide11Slide12National survey of 1,425 local EMS directorsRural and urban
Asked about the role of their medical director
MD responsibilities based on 2004
Rural and Frontier Agenda for the FutureSlifkin, et al. J Rural Health 2009;25(4):392McGinnis, K. National Rural Health Association 2004
Slide13Results of Survey
Responses: Overall response rate 60%
Rural: 60% of agencies responded
Urban: 55% of agencies respondedVolunteer agencies: Defined as no employee receives a regular salary or hourly wageExcept on call pay and pay for EMS runsVolunteer agencies:Rural: 49%Urban: 30%98% of agencies overall had designated medical directors
Slide14What is the Specialty Certification of YourMedical Director?
???
Slide15Specialty Certification ofMedical Directors
Emergency Medicine:
Rural: 42%
Urban: 82%Family or General Medicine:Rural: 44%Urban: 9%Does this matter to you?
Slide16Has Your Medical Director Undergone Training?
???
Slide17Medical Director Training
Has your medical director taken an EMS medical director course?
Overall: 55% of agency directors did not know
Of those who did know:Rural: 32% said their docs have taken a courseUrban: 37% said their docs have taken a courseDoes this matter to you?
Slide18Have you Had Trouble Recruiting Medical Directors?
???
Slide19Trouble Recruiting Medical Directors
“Yes”
Rural: 22%
Urban: 10%Reasons for difficulty (similar for rural/urban):Doctors not willing: 64%Cannot pay a medical director: 40%Local physicians not qualified: 18%
Slide20Off-Line Medical Direction79%: from medical director
42% from state EMS office
15%: other (local EDs, other EMS agencies)
(could list more than one source)
Slide21Other Medical Director Functions
77%: Develop protocol and standing orders
Develop or implement quality improvement programs:
Rural: 47%Urban: 53%Regularly review run reports:Rural: 43%Urban: 39%Review patient complaints:Rural: 58%Urban: 44%
Slide22Other Medical Director Functions
“Stay up-to-date on state, regional, or local information, changes in procedure, etc.”
Rural: 52%
Urban: 59%Does this matter to you?
Slide23What more would you like from your medical director?
29%: nothing more
71%: “I want more!”
What else would you like?Support for expanding scope of practiceRegular and timely run reviews / more QA/QIMore involvement in continuing medic education
Slide24Views from Utah Rural Medical Directors
Comments solicited from four rural Utah EMS Medical Directors
All discussed agency challenges
None discussed medical director pay or EMS malpractice issues
Slide25Views from Utah Rural Medical Directors
Challenges
Training: time/money
Funding:Is the “volunteer” model really the right answer?Police/Fire: usually have more fixed/reliable fundingStatewide tax/feesLocal “special service districts”“Surge”: managing rural mass gathering eventsStaffing: finding enough medics locallyEmployer constraints: losing staff for 3-4 hours at a time
Slide26Views from Utah Rural Medical Directors
Opportunities
Partner with urban agencies
Part-time staffingTraining/”ride-along” opportunities for rural medicsWebinar-type trainingAlternate funding sourcesLeverage State EMS and Office of Rural HealthGrantsEducational resources/supportConsolidation of local resourcesCommunity paramedicine/EMT hospital staffingFull-time local EMS employment?
Slide27Inactive
:
Active:
Types of EMS Medical Directors
Slide28Why do docs play with EMS?
They get paid (sort of…sometimes)
They didn’t show up to that meeting…
They’re the newest doc in town (“Tag, you’re it!”)They really care about the care of their patientsThey really care about their community
Slide29EMS Nationally
FICEMS: Federal Interagency Committee on EMS
Strategic national policies and agendas for EMS
NEMSAC: National EMS Advisory CouncilAdvises Federal Government on EMS-related issuesSets national priorities for EMS systems developmentNASEMSO: National Association of State EMS OfficialsAssociation of all state EMS officesMedical Directors Council: all of the state EMS medical directorsNAEMSP: National Association of EMS PhysiciansAssociation of EMS medical directorsACEP: EMS CommitteeNREMT, NAEMSE, AAA, NAEMT,
CoAEMSP
, IAFF/IAFC,
etc
…
Slide30EMS Scope of Practice
Slide31EMS Scope of Practice
EMR: Emergency Medical Responder
80-100
hr trainingBasic first aid, immobilization, dressings, splintingEMT: Emergency Medical Technician120-180 hr trainingLimited medication use: oxygen, oral glucose, epinephrine, narcan, NTGAEMT: Advanced Emergency Medical Technician200-300 hr training
IV skills,
supraglottic
airways, more extensive meds
Foundation of rural EMS
Paramedic
1800-2000
hr
training
Advanced airway management
Extensive medication use
Slide32EMS-C: EMS for ChildrenGoal: to ensure excellence in emergency care for kids
HRSA: Health Resources and Services Administration
Congressional funding source
Recommended ambulance equipmentRecommended ED equipmentPediatric performance measuresFunding for prehospital pediatric EBG developmentUtah EMS-C Medical Director: Dr. Hilary Hewes
Slide33Prehospital Evidence-Based Guidelines2006 IOM Report: “Emergency Medical Services at the Crossroads”
Advised the development of Evidence-based treatment protocols for prehospital Care
National Model Process for EBG Development
Slide34Slide35Current Prehospital Evidence-Based Guidelines
Cardiac arrest (AHA)
Pain management
Helicopter activationHemorrhage controlSeizures (peds)Respiratory distress (peds)Spinal Care (peds)*Shock (peds)*Allergic reactions (peds
)*
Airway management (
peds
)*
* Submitted for publication this year
Slide36NASEMSO Model EMS Clinical Guidelines
Created/maintained by NHTSA/OEMS grant funding
Collection of evidence- and consensus-based guidelines for prehospital care
States/agencies use them to develop prehospital treatment protocols
Slide37NEMSIS: National EMS Information SystemCollects and aggregates EMS data from states
Publically accessible for PI, analysis, research
Based at the University of Utah
Slide38EMS Compass
NHTSA/OEMS supported project
Standardized, evidence-based performance measures for EMS
Slide39EMS Compass Performance MeasuresSeizure
Hypoglycemia
Cardiac arrest
STEMIStrokeTraumaPediatricsOperational/Safety
Slide40Questions?
Discussion?