Medical Direction Toolbox

HEALTHCARE PROVIDER RESOURCES

Emergency Medical Services for Children (EMSC) National Resource Center (NRC). 

• Improving EMS Medical Direction for Pediatric Patients, An Internet Archive Webcast. This Internet presentation covers such topics as: performance measures in pediatric emergency care, on- and off-line medical direction, and pediatric prehospital protocols. This presentation archive is in video format, has slides, and is also available in transcript or audio-only formats. (Accessed November 2008)
  
  
• EMSC State Partnership Performance Measures. Federal grantees are required to report on specific performance measures related to their grant funded activities. The measures are part of the Government Performance Results Act (GPRA) and directly address operational capacity to provide pediatric emergency care, including development and adoption of online and offline pediatric medical direction. (Accessed November 2008)

• Care of Children in the Emergency Department: Guidelines for Preparedness. This document provides guidelines for necessary resources to ensure that children receive proper transfer to a facility with specialized pediatric services when appropriate. (2000)
  
  
• Direction of Prehospital Care at the Scene of Medical Emergencies. In this policy statement, ACEP asserts that the direction of prehospital care at the scene of a medical emergency should be the responsibility of the individual in attendance who is most appropriately trained and knowledgeable in providing prehospital emergency stabilization and transport. (2008) 
  
  
• Interfacility Transportation of the Critical Care Patient and Its Medical Direction. This policy statement asserts that a patient’s condition and the potential for complications should dictate the level of services available during interfacility transportation. Critical care transport teams are an important means of providing an appropriate level of care during the transfer of critically ill and injured patients. (2005)
  
  
• Medical Direction for Staffing an Ambulance. This policy statement asserts that the staffing of ambulances and other out-of-hospital emergency service vehicles should be subject to local EMS system physician medical direction. (2005) 
  
  
• Medical Direction of Emergency Medical Services. This policy statement asserts that all aspects of the organization and provision of basic (including first responder) and advanced life support emergency medical services require the active involvement and participation of physicians. ACEP also believes that EMS must have an identifiable physician medical director at the local, regional, and state level. (2005) 
  
  
• Physician Medical Direction of EMS Education Programs. A joint policy statement between ACEP’s EMS Committee and the National Association of EMS Physicians’ Standards and Practice Committee that discusses the role of the EMS education program medical director. The physician medical director should have authority over the medical content related to patient care for all courses in the EMS education program. The physician medical director should have a specific job description dictated by local needs. Recommended qualifications and responsibilities are listed. (1997) 
  
  
• Role of Emergency Physicians in Emergency Medical Services for Children. This policy statement asserts that emergency physicians, as leaders in EMS, have a pivotal role in the integration of emergency medical services for children. (2006)

• Emergency Care for Children: Growing Pains. The Institute of Medicine’s Committee on the Future of Emergency Care in the United States Health System was convened in 2003 to examine the state of emergency care in the U.S. and to create a vision for the future of emergency care. In 2006, it released this document which offers an analysis of: the role of pediatric emergency services as an integrated component of the overall health system; system-wide pediatric emergency care planning, preparedness, coordination, and funding; pediatric training in professional education; and research in pediatric emergency care.

• Model Pediatric Protocols.  These model pediatric protocols provide a basis for medical direction to create or refine existing protocols to meet local, regional, and state needs; set forth a standardized approach to pediatric treatment that can be employed by a wide variety of EMS systems; and serve as the ultimate authority for prehospital patient care rests with medical direction and the state EMS agency. (2003) 

• Role of the State EMS Medical Director. This position statement by the American College of Emergency Physicians, the National Association of EMS Physicians, and the National Association of State EMS Directors addresses the role of the medical director in the delivery of emergency medical services. (2005)

• Medical Director of Air Medical Transport Programs. This position statement affirms the multifaceted and integral position of a medical director for air medical transport programs and the EMS community at large. (2002) 

• Medical Direction of Interfacility Transports. This position statement serves as a guide to promote a safe and effective transport of a patient between facilities. (2000) 
  

• The Role of State Medical Direction in the Comprehensive Emergency Medical Services System. This joint document of the National Association of State EMS Officials, the National Association of EMS Physicians, and the American College of Emergency Physicians addresses the belief that physician medical directors at the state level are an essential component of EMS systems. The state EMS medical director provides medical aspects of leadership, oversight, coordination, access to best practices, system quality management, and research in order to assure the best possible EMS system for patients. (2003) $0$0 strong>Medical Directors Council. The Association’s Council develops recommendations on policies and positions specific to EMS medical direction and oversight. (Accessed November 2008)

• EMS Agenda for the Future. This document features an objective for medical direction within emergency medical services systems. (1998)

• North Carolina College of Emergency Physicians Standards for the Selection and Performance of EMS Medical Directors This document demonstrates state standards for EMS physician medical directors. (2005) 

EXAMPLE PRACTICES

• Colorado Department of Public Health and Environment. All emergency medical technicians in Colorado are required by Board of Health and Colorado Board of Medical Examiners rules to have a medical director if they are providing direct patient care as an EMT in any setting. EMTs in Colorado may function in prehospital and in-facility settings with appropriate medical supervision. EMTs provide patient care through delegated medical acts, defined by the Colorado Board of Medical Examiners (CBME). The CBME regulates this practice, which defines the roles and responsibilities of a medical director and the scope of practice for each of Colorado's levels of emergency medical technician. (Accessed November 2008)

• Idaho Guidelines for Medical Direction of Prehospital EMS. Physician direction of prehospital emergency care may be accomplished through off-line and on-line medical direction using prospective, concurrent, and retrospective methods. This web site lists the responsibilities and qualifications of medical directors to optimize prehospital emergency medical services, authority for medical direction, and obligations of an EMS agency. (Accessed November 2008)

• Iowa Department of Public Health, Bureau of EMS. Rules and recommendations pertaining to EMS providers performing under medical direction can be downloaded from this web site. A checklist is provided addressing the medical director’s responsibilities for protocols, continuous quality improvement, patient care report audits, and continuing education hours. The EMS Physician Medical Director Statement of Affirmation can be used as a model for other states requiring training of EMS medical directors. The Iowa prehospital emergency care protocols fully integrate pediatrics in all areas of medical care. (Accessed November 2008)

• New York State Department of Health. On May 31, 1995, the New York State Department of Health, Bureau of Emergency Medical Services issued Policy Statement # 95-01: Medical Control. The statement’s objective is to define the roles and responsibilities of the service, the service medical director, the Regional EMS Council, and the Regional Emergency Medical Advisory Committee in relation to this topic. This policy was intended to provide assistance to EMS agencies and physician medical directors so that they would better understand medical direction at the agency level. The current policy, issued on May 16, 2003, is intended to clarify and expand upon the definitions contained in the previous directive. It covers such topics as: Selecting an EMS Medical Director, Selecting an Emergency Health Care Provider (ECP) for Public Access Defibrillation or Epinephrine Auto Injector Programs, and Responsibilities of a Public Access Defibrillation Program ECP. (Accessed November 2008)

• West Virginia Office of Emergency Medical Services. The West Virginia Office of Emergency Medical Services provides a medical direction system for state EMS providers and the citizens they serve. The EMS Medical Direction System consists of the following components: State Medical Director, Regional Medical Directors, State Critical Care Committee, On-Line Medical Direction System, Regional Medical Command Centers, Communications System Infrastructure, Scope of Practice Development, Medical Practice Policy Formation, and Medical Advice on Issues. (Accessed November 2008)

FAMILY AND CAREGIVER RESOURCES

American College of Emergency Physicians

• Emergency Care of Children. This fact sheet answers questions that parents may have about emergency care for children, such as: which local emergency department is best for your child, what role do pediatric emergency specialists play in the care of your child, what emergency physicians are doing to improve the care of children, and how to make sure your child gets appropriate treatment in an emergency. (Accessed November 2008)

• Working with Families to Enhance Emergency Medical Services for Children. Developed by emergency care professionals and families who have experienced emergency care first hand, this guide is intended to help state and local emergency medical services agencies, EMSC grantees, hospitals, and family advocates explore the concept of family-centered care and apply it to pediatric emergency medical services. Practical information and tools for conducting internal family-centered assessments are also included. (2001)

• Patient- and Family-Centered Care Resources. This section of the Institute’s website includes a variety of resources for patients and their families and caregivers that promote their partnership in the delivery of health care services. (Accessed November 2008)