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  1. Physicians and EMS Services Must Align Medical Direction Expectations - Journal of Emergency Medical Services

    Subscribe | Newsletters | Advertise | Contact Us             Hello Edit Profile Logout Login or Register using Journal Supplements Subscribe Jobs Featured Jobs Search Jobs Post A Job Products Buyer's Guide Product Reviews Hot Products Hot Products Submissions Product Announcements Product Videos Technical Digests Webcasts White Papers Videos Ask the Expert Education & Training EMS 10 Interviews EMS Today Fitness JEMS Games Product Spotlight Home About Us Advertise Contact Us Our Team Authors Community News General News Industry News Company & People News Product Announcements Obituaries & Line of Duty Deaths Patient Care Abdominal & Gastrointestinal Disorders Allergies & Immunology Airway & Respiratory Cardiovascular & Hematology Diabetes & Endocrine Disorders Genitourinary & Gynecology & Renal Infectious Diseases Medications and Pharmacology Neurology Patient Assessment Psychiatric Resuscitation & Shock Toxicology Trauma Abdominal & Genitourinary Trauma Bleeding Burns & Soft Tissue Trauma Chest Trauma Environmental Emergencies Head, Neck, Spine and Nervous System Trauma Orthopedic Trauma Special Patients Geriatrics Obstetrics and Neonatal Pediatrics Special Challenges Administration & Leadership Communications & Dispatch Documentation & Patient Care Reporting Education and Training Leadership & Professionalism Legal & Ethical Protocols & Medical Direction Operations Ambulance & Vehicle Ops Air Medical Equipment & Gear Hazmat Provider Wellness & Safety Rescue & Vehicle Extrication Tactical EMS Major Incidents Mass Casualty Incidents Natural Disasters Planning & Incident Management WMD & Terrorism Mobile Integrated Healthcare Special Topics Case of the Month EMS Today Conference Hands On Product Reviews History of EMS Humor JEMS Games Research Surveys Technology   Home About Us Advertise Contact Us Our Team Authors Community News General News Industry News Company & People News Product Announcements Obituaries & Line of Duty Deaths Patient Care Abdominal & Gastrointestinal Disorders Allergies & Immunology Airway & Respiratory Cardiovascular & Hematology Diabetes & Endocrine Disorders Genitourinary & Gynecology & Renal Infectious Diseases Medications and Pharmacology Neurology Patient Assessment Psychiatric Resuscitation & Shock Toxicology Trauma Abdominal & Genitourinary Trauma Bleeding Burns & Soft Tissue Trauma Chest Trauma Environmental Emergencies Head, Neck, Spine and Nervous System Trauma Orthopedic Trauma Special Patients Geriatrics Obstetrics and Neonatal Pediatrics Special Challenges Administration & Leadership Communications & Dispatch Documentation & Patient Care Reporting Education and Training Leadership & Professionalism Legal & Ethical Protocols & Medical Direction Operations Ambulance & Vehicle Ops Air Medical Equipment & Gear Hazmat Provider Wellness & Safety Rescue & Vehicle Extrication Tactical EMS Major Incidents Mass Casualty Incidents Natural Disasters Planning & Incident Management WMD & Terrorism Mobile Integrated Healthcare Special Topics Case of the Month EMS Today Conference Hands On Product Reviews History of EMS Humor JEMS Games Research Surveys Technology Home Physicians and EMS Services Must Align Medical Direction Expectations Physicians and EMS Services Must Align Medical Direction Expectations Wed, Jul 15, 2015 By Mark E.A. Escott, MD, MPH, FACEP I recently posted the question, "How much medical direction do we need?" to an EMS physician listserv. The result? It turns out the old saying about EMS services applies: If you've seen one EMS medical direction system, you've seen one EMS medical direction system. There are wildly different models across and within states. I'm often faced with questions from new EMS fellowship graduates who've been approached by systems regarding what they should charge for their service as a medical director. My first response is always the same: "How much of your time do they need?" This is a difficult question to answer for many EMS organizations. The default answer is to go with the same amount of time the last medical director spent. Others use calculations based on various factors in the service such as call volume, number of ambulances, number of ALS providers, etc., to create an oversight ratio. If we look at "span of control" models to help guide us in the search for a magic oversight ratio, we should start with the military. The ratio for command and control is 6:1, which creates 222 separate relationship possibilities when you consider the complexity of the task. If the ratio changes to just 8:1, the relationship monitoring of the supervisor changes to 1,080 relationships. In the EMS world, however, in regards to the medical director, we aren't talking about supervision of workplace relationships and if they show up on time for duty; we're strictly monitoring their individual clinical performance as well as system-based metrics. This, combined with electronic medical records, may lend itself to larger ratios. [Native Advertisement] In addition to the number of personnel EMS physicians are providing oversight for, we also must consider the number of patient encounters. The very brief and limited survey results on my recent listserv query revealed a ratio among the six or so counties and cities with call volumes over 30,000 that responded with specific information that the ratio of physician full-time employees (FTE) to call volume was from 0.2–1.0 FTE per 30,000 calls. Major metropolitan areas tend to have the most advanced structure regarding medical direction, which usually includes lower-cost EMS fellows. These services on average had physician-to-call ratios of 1:27,000. We must advocate for more comprehensive salary and effort surveys for medical directors so that we have a more educated approach to determining the effort needed. The truth is that there's no golden ratio we can refer to when determining the amount of medical direction needed. If we look again to the closest comparison of the oversight of physician assistants by supervising physicians, we see more specific guidance in many states. For instance, in Texas the limit is seven, in Florida eight, but in California and New Jersey it's four. While there are exceptions to specified ratios (Massachusetts removed its ratio law in 2012), the general consensus seems to be that there's a limit in the ability to effectively supervise people who are practicing under one's medical license. Medical directors and EMS services together need to renew this dialogue about appropriate levels of oversight in this new age of EMS. We've pushed new technology in the field, we've added complexities such as paramedic-initiated non-transport of patients and community paramedicine. We can't continue to advance the field of paramedicine to make paramedics more like physician's assistants without expecting the oversight requirements to become more rigorous. Where Do We Go from Here? I've been asked by many EMS services how to get their medical director more engaged. My first response is to ask how much they're paying their medical director, and how much time they expect them to be around. The reality is that the average emergency medicine physician is making $150–200 per hour, which is less than an EMS service pays per hour for a decent contract attorney. I know that some EMS services are offering medical directors $75–100 per hour. What are the chances you're going to find a good attorney for $75 per hour? How interested would your paramedics be in coming to work if you paid them half of what they could make working as a medic in the ED? The flip side of this argument is that if an EMS service is paying the medical director's regular clinical rate, in effect "buying down" their other responsibilities, they should be giving you the amount of time that you buy, period! Some medical directors want EMS services to pay for using their medical license and accepting the liability without providing the in-person service necessary to ensure the quality of care delivered by every credentialed paramedic meets the highest standard. Physicians are an essential part of an EMS service and it's time both of our expectations align so we can all answer the question of how much medical direction we need. By Mark E.A. Escott, MD, MPH, FACEP Mark E.A. Escott, MD, MPH, FACEP, is the medical director/founder of Rice University EMS. He’s the founder/director of the Baylor College of Medicine EMS Collaborative Research Group, where he’s also the director of the Division of EMS and Disaster Medicine and an assistant professor in the Section of Emergency Medicine. He’s Montgomery County’s public health authority and is board certified in emergency medicine and subspecialty board certified in EMS. Sponsored Content is made possible by our sponsor; it does not necessarily reflect the views of our editorial staff. Subscribe today to  JEMS In EMS, you never know what you'll be faced with as each new shift begins. The Journal of Emergency Medical Services (JEMS) is real-world EMS. It's informative, practical and an outstanding educational resource for EMS professionals. We're here to help you do your job more effectively, with content from writers who are EMS professionals in the field: Breakthrough Clinical Concepts Cutting-Edge Technology Annual Salary Survey Leadership & Professionalism Fundamental Assessment Tips New Product Reviews Compelling Case Studies and more... SUBSCRIBE DIGITAL EDITION   RECENT ARTICLES An Evidence Review of Prehospital Spinal Immobilization Evidence continues to show that it’s time for a change in field practice and that traditional stabilization methods are overused. Help Clinicians Take Control of the Self-Directed Learning Process The ultimate step in being a true clinician is understanding what literature to read and how to analyze the data. American College of Surgeons Releases Hartford Consensus Compendium The September, 2015 American College of Surgeons Bulletin is devoted to Active Shooter and Intentional MCI incident event preparedness and response. Making the Case for EMS Work Hour Restrictions There are two main and distinct areas of concern in relation to EMS: The capacity to drive an emergency vehicle, and the ability to make critical decisions and perform critical skills on patients a... Apply Facts to Become an Anticipatory Clinician The EMS physician must be engaged in their EMS service in order to make sure providers are practicing practical and evidence-based medicine and utilizing current technology in their critical decisi... Child Abuse Laws Must Be Taught to All EMS Providers Additional hours of training are needed to engrain the responsibility we in EMS have toward our most vulnerable patients. Journal Archives Prev 2015 2014 2013 2012 2011 2010 Next Dec 2015 Volume 40 Issue 12 Nov 2015 Volume 40 Issue 11 Oct 2015 Volume 40 Issue 10 Sep 2015 Volume 40 Issue 9 Aug 2015 Volume 40 Issue 8 Jul 2015 Volume 40 Issue 7 Jun 2015 Volume 40 Issue 6 May 2015 Volume 40 Issue 5 Apr 2015 Volume 40 Issue 4 Mar 2015 Volume 40 Issue 3 Feb 2015 Volume 40 Issue 2 Jan 2015 Volume 40 Issue 1 Prev 2015 2014 2013 2012 2011 2010 Next SUBSCRIBE DIGITAL EDITION   Featured Careers More Jobs   eNews Register for the JEMS eNewsletter, it's FREE! Sign-Up! JEMS Connect FEATURED GROUPS Disaster EMS   EMERGENCY! Lovers   Tactical Medicine   Humor In EMS     CURRENT DISCUSSIONS   JOIN JEMS CONNECT   EMS BLOGS Blogger Browser Today's Featured Posts Copyright © 2015: PennWell Corporation, Tulsa, OK. All Rights Reserved. UTILITY Home About Us Contact Us Terms of Use Subscribe Advertise Reader Service RSS Feeds Privacy Policy Topics News Patient Care Leadership Special Topics Major Incidents Operations Sections Authors Columns Community Jobs Journal Products Supplements Webcasts Complete Registration Please fill out the remaining fields to complete your registration. Login Don't have an account? Register now Login with your social account: or Or, login with your PennWell account: Register Already have an account? Login Join using your social account: or Or, register with us using the form below: Forgot your password? Enter your email address below and click Submit to receive password reset instructions via email. Email Sent An email has been sent to . Please follow the instructions in the email to change your password. Welcome to PennWell Your account has been created and you are now logged in. You already have an account It looks like you've already registered with . Please login below to link your accounts. Please Verify Your Account Thank you for registering. An email has been sent to with instructions on how to verify your account. Please Verify Your Account The specified email address, , needs to be verified in order to login. An email has been sent to with instructions on how to verify your account. /content/jems/en/articles/print/volume-40/issue-7/departments-columns/field-physicians/physicians-and-ems-services-must-align-medical-direction-expectations.resendverification.html

    Magazine Articles

    Magazine Articles

    Wed, 15 Jul 2015

  2. Rethink the Way EMS Does Patient Care Reports - Journal of Emergency Medical Services

    EMS must let go of the idea prehospital care documentation is strictly about billing and creating a legally defensible record of events.

    Magazine Articles

    Magazine Articles

    Tue, 5 May 2015

  3. DCFEMS Medical Director Leaves for New Post - Journal of Emergency Medical Services

    WASHINGTON - Washington DC EMS Chief and Medical Director, Dr. David Miramontes, will be leaving the Nation’s Capital to assume a position as Assistant Clinical Professor of Medicine at the University of Texas Health Science Center in San Antonio (UTHSC) and serve as the physician medical director ...

    Online Articles

    Online Articles

    Mon, 1 Sep 2014

  4. How the University of New Mexico’s EMS Medical Direction Consortium Encourages Collaboration - Journal of Emergency Medical Services

    New Mexico, also called the Land of Enchantment, is known for its hot chilies, adobe buildings and pink sunsets. It has a long and fascinating multicultural history. It is the fifth-largest state by land area and consists of a small population of only about 2 million people. Outdoor activities ...

    Magazine Articles

    Magazine Articles

    Tue, 4 Jun 2013

  1. Sirius XM to Feature EMS Segment - Journal of Emergency Medical Services

    Online Articles

    Online Articles

    Tue, 1 May 2012

  2. 30 Life Lessons: JEMS Editorial Board Members Offer Words of Wisdom - Journal of Emergency Medical Services

    Lead boldly—with kindness and a deep respect for others! This brings out the best in your organization and all you serve. —Jay Fitch, PhD, President & Founding Partner, Fitch & Associates

    Magazine Articles

    Magazine Articles

    Mon, 1 Mar 2010

  3. Life Lessons - Journal of Emergency Medical Services

    Lead boldly -- with kindness and a deep respect for others! This brings out the best in your organization and all you serve. Jay Fitch, PhD,  President & Founding Partner, Fitch & Associates

    Magazine Articles

    Magazine Articles

    Mon, 1 Mar 2010

  4. EMS and the DEA - Journal of Emergency Medical Services

    Case #1

    Article

    Article

    Fri, 1 Jan 2010

  5. EMS and the DEA - Journal of Emergency Medical Services

    Case #1

    Online Articles

    Online Articles

    Fri, 1 Jan 2010

  6. The Electronic Crossroads - Journal of Emergency Medical Services

    It was a dark and stormy night. One of the largest hurricanes in recorded history curved through the Gulf of Mexicotoward southern states terrified and cowering at its approach, and crashed into Louisiana and Mississippi on Aug. 29, 2005, evoking a blackout of agonizing proportions.

    Article

    Article

    Thu, 1 Oct 2009

  7. The Electronic Crossroads - Journal of Emergency Medical Services

    It was a dark and stormy night. One of the largest hurricanes in recorded history curved through the Gulf of Mexicotoward southern states terrified and cowering at its approach, and crashed into Louisiana and Mississippi on Aug. 29, 2005, evoking a blackout of agonizing proportions.

    Online Articles

    Online Articles

    Thu, 1 Oct 2009

  8. Have You Seen Your Medical Director Lately? - Journal of Emergency Medical Services

    It's a hot summer afternoon in Palm Beach County, Fla., and Palm Beach County Fire Rescue-73 is staffed with three personnel -- two paramedics and one EMT. They have a total of five years' experience, and they're en route to the local trauma center with a head-injured patient. The ...

    Online Articles

    Online Articles

    Wed, 29 Apr 2009

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