EMS MEDICAL DIRECTION OVERVIEW Ritu Sahni, MD, MPH, FAEMS

Medical Director

Washington County

ANY QUESTIONS?

WHERE DOES THE MEDICAL DIRECTOR FIT?

“The physician who has the ultimate responsibility to provide management, supervision, and guidance for all aspects of EMS in an effort to assure its quality of care” (EMS Agenda)

“under the license”?

Responsible for agency, system

Patient Care Activities

Operational Activities Medical Director

Administrative Director

WHAT IS MEDICAL OVERSIGHT?

“Medical Oversight is the activity of physicians…to ensure the EMS providers and EMS systems provide optimal medical care.”

Off-line vs On-line

Direct vs Indirect

Prospective, Concurrent, Retrospective

OVERSIGHT?

Direct or On-line

OVERSIGHT

Indirect or Off-line – Initial Education

– Ongoing education

– Protocol development

– Chart review

– Data collection and review

– …Coffee with the Chief

EMS MEDICAL DIRECTOR

Focal point for medical leadership

a cooperative process

others potentially involved – physicians, PAs, NPs, nurses, EMS personnel

Other physician specialists – EM, trauma, cardiology, peds, FP

Interface and liaison with medical community

MEDICAL DIRECTOR QUALIFICIATIONS

Active involvement in emergency care of patients - in ED and field ideal

– spend time in the field

knowledge of EMS systems and operations

unrestricted medical license

EMS is now a subspecialty

CLINICAL CARE ISSUES Protocol considerations

– personnel training / re-training

– medications stability

storage

control

– administrative issues

– equipment issues

– new modalities

– $$$

ROLE OF EMS MEDICAL DIRECTOR

Physician as patient advocate

Physician as team leader

Physician as legal component of system

Physician as link to health care system

EMS EDUCATOR

Medical oversight for education programs Direct educators for both Initial Continuing

MEDICAL DIRECTORS ON THE SCENE

EMS FIELD PHYSICIANS

WHAT DOES STATE LAW REQUIRE?

All EMS practitioners are required to have medical director and a set of protocols (standing orders)

All EMS agencies are required to have a Medical Director (supervising physician)

“Physician Advisor” is not a current term and not accurate

(a) Be a medical or osteopathic physician currently licensed under ORS Chapter 677, actively registered and in good standing with the Board;

(b) Be in current practice; (c) Be a resident of or actively practicing in the area in which the emergency service is located; (d) Possess thorough knowledge of skills assigned by standing order to emergency medical services

providers; and (e) Possess thorough knowledge of laws and rules of the State of Oregon pertaining to emergency

medical services providers; and (f) Have completed or obtained one of the following no later than one calendar year after beginning the

position as a supervising physician: (A) Thirty-six months of experience as an EMS Medical Director; (B) Completion of the one-day National Association of EMS Physicians (NAEMSP®) Medical Direction

Overview Course, or an equivalent course as approved by the Authority; (C) Completion of the three-day National Association of EMS Physicians (NAEMSP®) National EMS Medical

Directors Course and Practicum®, or an equivalent course as approved by the Authority; (D) Completion of an ACGME-approved Fellowship in EMS; or (E) Subspecialty board certification in EMS.

(5) A supervising physician must meet ongoing education standards by completing or obtaining one of the following every two calendar years:

(a) Attendance at one Oregon Health Authority EMS supervising physician’s forum; (b) Completion of an average of four hours of EMS-related continuing medical education per year; or (c) Participation in maintenance of certification in the subspecialty of EMS.

OMB – MEDICAL DIRECTOR QUALIFICATIONS

PORTLAND METRO MEDICAL DIRECTION *BOARD CERTIFIED IN EMS

Multnomah County Single Medical Director for all agencies – Jon Jui, MD, MPH*

Associate Medical Directors Elizabeth Hatfield-Keller, MD

Mike Murray, MD

Greg Lorts, MD

PORTLAND METRO MEDICAL DIRECTION *BOARD CERTIFIED IN EMS

Clackamas County Terri Schmidt, MD, MS

County Medical Director American Medical Response 9-1-1 and SAR

- Ritu Sahni, MD, MPH, FAEMS Associate County Medical Director Lake Oswego Fire Dept American Medical Response

Craig Warden, MD* Clackamas County Communications Clackamas Fire District 1

Marc Houston, DO AMR – non-emergency

Mohamud Daya, MD, MS* TVFR

Sean Stone, MD Canby Fire Molalla

PORTLAND METRO MEDICAL DIRECTION *BOARD CERTIFIED IN EMS

Washington County Ritu Sahni, MD, MPH, FAEMS

County Medical Director Metro West Ambulance – 9-1-1 service

Terri Schmidt, MD, MS Associate County Medical Director Metro West Ambulance – 9-1-1 service

Mohamud Daya, MD* Banks Fire District 13 Cornelius Fire Department Forest Grove Fire & Rescue Gaston Rural Fire District Tualatin Valley Fire & Rescue Washington County Consolidated Communications Agency

Matt McCoy, MD Metro West – non- emergency service

Mike Shertz, MD* Hillsboro Fire

PORTLAND METRO MEDICAL DIRECTION *BOARD CERTIFIED IN EMS

Tualatin Valley Fire And Rescue Mohamud Daya, MD, MS* - Medical Director

Associate Medical Directors John Heiser MD

George Apostolopoulos MD

Matt Hansen MD – Pediatric emergency specialist

Protocol Development Committee Voluntary regional protocol development

Multi-disciplinary group All regional Medical Directors

Each participating agency has a practitioner

Meets monthly

Develops protocols over a 1 year timeline

New protocols training in December with “Go-live” in January

SUMMARY

EMS Medical Direction is specialty with specific knowledge, skills and ability.

Multiple models for Medical Direction in each county

Protocols are evidence-guided and developed by a large panel of experts.

THE END