The feature article "Professional Medical Direction" in March 2006 JEMS includes quotes from medical directors across the U.S. As a bonus, we share with you the following interview of Jay Lance Kovar, MD, FACEP, the medical director for Conroe (Texas) Regional Medical Center Emergency Department, Montgomery County Hospital District (MCHD) EMS (an ALS ground service based in Conroe) and Petroleum Helicopters Inc. (PHI) Air Medical (a rotor and fixed-wing air provider with multiple bases in Texas).
From the physician's perspective, what should field providers know about medical direction?
Medical direction begins with understanding current practices of medicine and striving to update and adapt them to prehospital care. Medical direction is a practice of medicine, delegated to those individuals possessing the skills and knowledge to apply them in emergent care situations. The medical director cannot detach himself from, nor should he be shielded from that responsibility. Even a "part time" medical director must know that his care protocols and impact on patient lives are "full time." Field providers should expect this level of involvement and responsibility. Field providers must remember they are working in a relationship that requires a high degree of trust and professionalism.
If another physician were to seek your counsel regarding medical direction, how would you advise them?
Search out your reasons for consideration [of the medical director position]. There is no status and often very little monetary reward in this endeavor. The rewards of touching lives in the balance for a greater outcome must drive this task. You must be aware that the design of medical care delivered and the method in which it is delivered is a direct responsibility. The position is that of developer, reviewer, counselor, teacher, negotiator and politician. You must feel a comfort with the system and its ability to support the role you assume. Involve yourself in professional medical direction societies for their insight and support.
How do being medical director for a ground service and being medical director for a flight service differ?
The difference can be broad, dependent upon the variability of some ground EMS [agencies]. Air medical EMS crews must assimilate not only EMS scene response but also critical care transport. Skill and knowledge expectations are generally higher from consumers, often requiring care outside traditional ground unit training. Because of a broader reach with air EMS, the political influence crosses over larger territories, agencies, and hospitals. Fewer calls, higher acuity and risk, twice the headache, same reward.
How would you describe your medical direction "style"?
Benevolent dictator. Policies, protocols, teachings and reviews are designed to best benefit the patients we serve in a manner that accounts and understands the hardships of providers. Listen, learn and adapt from errors without broadening tolerance for them.
How has your style changed through years as a medical director?
I am still learning. Communications have become easier, yet more direct. I have learned that a good system is far greater than a good director.
What (if anything) have you learned about medical direction from field personnel?
Nothing is ever as simple as can be put on paper. Illness and injury do not follow the rules. Develop a plan, then prepare to adapt. Teach critical thinking skills as well as medical regimen. I know where the buck stops.
Providers who work under Dr. Kovar's guidance appreciate his style. They have this to say about him:
From Lee Gillum, EMT-P, MCHD EMS
Dr. Kovar sees through the eyes of his paramedics and understands their
challenges in patient care. Unlike most MDs who require you [to] see through their eyes, he trusts our clinical knowledge and judgment.
Dr. Kovar is always willing to evaluate new concepts and trends in emergency medicine, allowing MCHD EMS to be on the leading edge of EMS healthcare in the United States.
From Casey Aaron-Wood, AAS, LP, Clinical Specialist, MCHD EMS
Jay Kovar supports the quality assurance program and doesn't make conclusions until he has all the facts. He supports the promotional process as well as the educational program offered at MCHD. He challenges employees to be their best with progressive and comprehensive protocols.
From Heath Manson, Paramedic, PHI Air Medical (and previous MCHD EMS Field Supervisor)
Dr. Kovar doesn't mind getting dirty and getting in the middle of what EMS is all about. He is actively involved and available 24/7/365 for questions, concerns or anything that we need.
Dr. Kovar has taught me how to be innovative and to think outside the box for the best interest of the patient. He has taught me that every patient doesn't fit the stereotype and that innovation, within limits, may be required.
Dr. Kovar has inspired ... confidence in myself. When your medical director tells you that he hired and authorized you to function under his license because of your demonstrated ability to always use good judgment, and his expectation is that you use good judgment always, that really says something.
For more resources on medical direction, check out these links:
National Registry of EMTswww.nremt.org
National Association of EMTswww.naemt.org