Handbook for EMS Medical Directors March 2012 This page was intentionally left blank. U.S. Fire Administration Mission Statement We provide National leadership to foster a solid foundation for our fire and emergency services stakeholders in prevention, preparedness, and response. This page was intentionally left blank. Preface Preface Colleagues: The Department of Homeland Security (DHS) Office of Health Affairs (OHA) and the U.S. Fire Adminis- tration (USFA) are pleased to deliver this Handbook for EMS Medical Directors of local departments and agencies involved in emergency medical services (EMS) response. Medical directors provide critical oversight and medical direction to ensure that effective emergency medi- cal care is provided to millions of patients throughout the United States. In addition to providing medical oversight and direction, EMS medical directors support EMS personnel and first responders through train- ing, protocol development, and resource deployment advice. This handbook provides a baseline overview of key roles and responsibilities to assist current and prospective medical directors in performing their im- portant missions. On behalf of the U.S. DHS, we thank you for your service to the Nation’s EMS. Sincerely yours, Alexander G. Garza, M.D., M.P.H. Ernest Mitchell, Jr. Assistant Secretary for Health Affairs and U.S. Fire Administrator Chief Medical Officer i This page was intentionally left blank. ii Table of Contents Table of Contents Preface .................................................................................................................................i Acknowledgements ............................................................................................................ 1 Introduction ....................................................................................................................... 3 The EMS Agency and Its Stakeholders ............................................................................... 5 Overview ..................................................................................................................................................... 5 EMS History ................................................................................................................................................. 5 The Modern EMS System ............................................................................................................................. 9 EMS Agency Design Types ..........................................................................................................................10 Multiple-Role EMS Agency ................................................................................................................................ 10 Single-Role EMS Agency .................................................................................................................................... 11 Hospital-Based EMS Transport Agency .................................................................................................................. 11 Private EMS Agency ......................................................................................................................................... 11 Third-Service EMS Agency ................................................................................................................................. 11 Public Utility EMS Agency ................................................................................................................................ 11 EMS Agency Staffing Types .........................................................................................................................11 Career .......................................................................................................................................................... 12 Volunteer ....................................................................................................................................................... 12 Combination .................................................................................................................................................. 12 Types of Response Service ..........................................................................................................................12 Single-Tier Response Service................................................................................................................................ 12 Tiered Response Service ...................................................................................................................................... 13 Resource Deployment ................................................................................................................................13 Fixed Deployment ............................................................................................................................................ 13 Dynamic Deployment ....................................................................................................................................... 13 Emergency Medical Dispatch .....................................................................................................................13 Emergency Response Components ............................................................................................................14 Disasters or Multiple and Mass Casualty Incidents .................................................................................................. 15 Technical Rescue or Medical Search and Rescue ........................................................................................................ 15 Special or Mass Gatherings Events ........................................................................................................................ 16 Hazardous Materials ......................................................................................................................................... 16 Wildland ....................................................................................................................................................... 16 Tactical EMS .................................................................................................................................................. 17 Becoming a Medical Director...........................................................................................19 Role and Purpose of the Medical Director ..................................................................................................19 Scope of Responsibility ..............................................................................................................................19 Agency Oversight ............................................................................................................................................. 19 Education and Training of the Medical Director .........................................................................................20 Postgraduate Education ...................................................................................................................................... 20 State Requirements ........................................................................................................................................... 20 Consensus Standards and Professional Associations ................................................................................................... 21 Agency Training ............................................................................................................................................... 22 Continuing Education for the Medical Director ....................................................................................................... 22 Affiliation Agreements ................................................................................................................................22 iii Table of Contents Hire/Employee ............................................................................................................................................... 23 Independent Contractor ...................................................................................................................................... 23 Memorandum of Understanding and Memorandum of Agreements ............................................................................... 23 Performance Expectations ..........................................................................................................................24 Compensation and Benefits ........................................................................................................................25 Workers’ Compensation ..................................................................................................................................... 25 Continuing Education ....................................................................................................................................... 25 IRS Requirements ............................................................................................................................................. 25 Dissolution ..................................................................................................................................................... 26 Liability Coverage .......................................................................................................................................26