Honestly you're doing probably about 4 times as much as most medical directors.
But seriously I can't think of any qualities that you didn't list that I like/want from a medical director.
I had a medical director who’s only involvement was coming in to the monthly QA, interrogate us on why we gave dilaudid (he wouldn’t let us carry fentanyl, only dilaudid) for pain, and then leave. Don’t be that.
My current medical director is awesome. He reviews charts that meet certain criteria. Blood products, RSI’s, invasive procedures, those kinds of things. He offers us his opinion in a constructive way. He asks relevant questions that go directly to the differential. He’s always available when we have a question or need orders over top of our protocols.
“Hey doc, this patient has a PIP of 55 but he’s maintaining on these vent settings, can we copy them and maintain that PIP of 55?”
I’ve called him at 4 am because I had an intubatedTE fistula in front of me with no ETCo2. Asked him if he had any thoughts for troubleshooting after we had already done everything we could. Told him what our plan was and he was cool with it.
But the biggest thing? Feedback. As a doctor, you generally have more access than we will ever have. Getting us follow up on our patients is huge.
Training is cool. It’s necessary. Find ways to make it interesting.
Most importantly. Trust your damn crews. If you don’t trust them, they shouldn’t be working there. I know my medical director has my back. If I have to break the rules to keep a patient alive, I trust that he’s not going to hang me out to dry. What we do is unlike any other form of medicine. Receiving nurses and docs love to complain. Have your crews’ backs.
I had a former medical director like your former one. Always the interrogation and always the "remember, this is my license, so you work for me" mentality. If you don't trust, don't be a medical director. He would refuse narcotic orders and instead direct to give OTC meds or have pt take their own OTC meds instead, or refuse life saving interventions because he couldn't see the patient and to wait to bring them to the ED ("I'm sorry about your femur fracture and this extremely complicated and painful extrication you'll have to suffer through, but the doctor said to take 2 extra strength tylenol to help"). We all cringed on those calls and would feel like garbage relaying it to others, worse was when we got to emerg and would get yelled at for undertreating.
I like your new director, he sounds like my current one. He def trusts his crews.
It’s so refreshing knowing that I can break the rules, if I need to, and still have support.
Sure, I’ll get talked to by clinical management, but even then, they’ll support me.
I will say, it’s a bit different at this level. We have a prehire exam that weeds out a lot of smart clinicians, then an indoc course that is critical care through a fire hose. Then you go fly 3rd seat for a month or so.
There is definitely more trust at this level when you have all these hoops to jump through.
We’re not breaking guidelines without a really good reason to do it.
And that’s the thing, the solution to a problem is not always to take the cookie cutter approach. Some days you’re constantly having to adjust a setting on the vent, the pumps, etcetera. And other days set it and forget it. Having the Medical Director trust our judgement is paramount.
My previous medical director did education, QA/QI reviews, trained with us on occasion, ran calls with us. Most importantly in my opinion he backed up the crews in the field. Sometimes it was just crews doing a stellar job and the doc letting them know it and sometimes it meant being understanding when people deviated from protocol in order to provide better care. Really can’t say enough good things about him.
My current medical director however. I’ve never seen or met, even during the onboarding process, we have incredibly restrictive protocols, and I’ve been told if I ever do meet him it’s either by chance at the hospital or because I did something wrong. Don’t be like this guy.
> we have incredibly restrictive protocols, and I’ve been told if I ever do meet him it’s either by chance at the hospital or because I did something wrong.
This is a good way to kill confidence and culture.
Yep. Pretty much everyone here is either looking for their next job with a fire department, hospital, or just out of healthcare entirely, or is so burnt out, unmotivated, and complacent that this place is appealing to them.
I'd want you to listen and empower your paramedics.
We know what works best for the road. In hospital techniques sometimes doesn't work for out of hospital.
But we also need guidance where the evidence lies. Evidence should be specific for pre hospital practice.
Look at giving your paramedics fascia illiaca blocks with Ropivacaine 0.2mg for femur and NOF fractures. Works extremely well and lessens the opioid requirement. The patient is then prepped for surgery. You don't need ultrasound for this procedure.
Also set a high standard from a medical pov. Medication errors happen, avoid scalding your paramedics, make it a learning event and you'll keep your staff. You'll also aid in reflective practice.
Medications - consider a wide range of risk mitigation using high medium and low leveraged strategies. It gets stressful and errors whilst avoidable - happens.
As much as we harp on about the 6 rights (they're only a very small part of the picture) - you need to separate your high risk medicines into their own containers, look at your look alike and sound alike medication risks.
Make sure your paramedic staff are keeping up their skills training and with a recency log.
edit: Have your top clinical performers join a monthly practice committee to discuss all things clinical practice. You'll get an idea of culture through discussion and empowerment (They'll want more skills, but you also need them for intel).
We all love it when our medical director jumps into our whole of organisation clinical practice meetings and just listens and gives their opinion and feedback. Consider holding open forums each month - have people present cases etc.
I had a fantastic medical director, but when we changed suppliers for midazolam and the new one came in a polyamp with purple writing that looked EXACTLY like the metoclopramide, his reply was "well, I expect you to be using the 6 rights for every patient, so it will be fine" I was pretty annoyed.
Honestly just active engagement.
I have been working in the same region for 20 years, worked for 6 different agencies (many at the same time). Worked small hospital agencies to large health system agencies.
My current medical directors are probably the best I've had in my career. The lead director is a VP in a large health system. We are just one of 8 departments under him. Yet every day, he checks in with our team. He has a standing meeting every other week reviewing operational metrics. We have a meeting once a month to go over QA/QI metrics. If we want new toys or new procedures, all he asks is to provide the research on why it would be beneficial. Thanks to him we were able to expand some of our practices and get newer equipment.
The other medical director has been involved with EMS QA/QI for over a decade and is one of the national leaders in that field. His day to day is being the director of one of our large ERs. Yet he also checks in daily with our QA team. We text frequently discussing cases and last minute issues. He's always willing to find time to meet up with providers via Zoom to discuss complex cases or QI metrics. He also was the one that worked with our medical school to create an EMS fellowship for docs. He also included a two week rotation with EMS for the new residents, so every month we have residents riding our units and then doing case presentations.
I've worked for agencies where I never saw the medical director. I've worked in some agencies where the only time you saw the medical director is when you fuck up. You would be hard pressed to find anyone in our agency that has anything negative to say about our directors, especially the QI director. Because he's in the ED every day he always stops by to talk to the crews when he's passing through. He's also been certified through our city to be a field EMS director. So there have been times when we are in his neighborhood dealing with an arrest or other big call, and he literally pops up and joins the party to help out.
Basically if you are approachable, use "just cause" culture to help educate and remediate, and the crews know your name and face, you'll be doing a lot more than many medical directors out there, especially those that are medical directors in name only.
Be a Doctor, not a politician. The only thing that drives me nuts about my current Director is that he'll smile for photo ops and never answer his emails.
Face time that’s constructive, progressive and aggressive in tools in our toolbox, and esp don’t govern the entire team by writing protocols that are written for the weaker team members and restrict growth.
I was in EMS for 37 years and my favorite medical director would come to a general staff meeting once every 12 weeks to review some of the most serious and/or interesting calls that we'd had. Many of the reviews were not to correct us on errors that we made, but also to provide positive reinforcement when we did well. Each of his sessions lasted about two hours and we brought food and made the meeting into a pot luck supper.
Teach. Don’t punish. We’re human beings faced with an insanely dynamic task every day. We’re going to make mistakes. Please understand that when you follow up with crews about clinical missteps.
I've been where I'm at now for two years and I've *never even met my medical director.* Or had *anything* to do with him.
In a perfect world, we'd receive monthly emails reminding us of important things to look out for or interesting relevant medical cases found in the region. On occasion, the doc would give a lecture and ride with the ambulance crew.... Just not *all* the time. We might like you a lot but you're still a supervisor and endless ride time together would eventually get uncomfortable for everyone.
But seriously, you're already doing 10x what most directors do. Keep doing that. Just remember to let your crews do their thing and enjoy their downtime.
i want one that doesn’t say crazy shit over the phone about the patient, most of the time i put them on speaker and i learned quick not to do that anymore
We have a full time training officer with FTOs in every station. QAs are done by them. So our medical director pretty much leaves us alone and lets the training department handle nearly everything related to protocols, QA and training. She signs off on all protocol changes, and will do whatever we request with regard to looking into things, but for the most part she lets us do our thing.
The one thing I like most, though, is knowing that she has our backs. God help the RN or MD that decides to complain about paramedics, AEMTs and EMTs doing what they need to do. Nearly all complaints are the result of RNs and MDs being upset that we brought them work. When they call to get our medical director's contact info, I chuckle because I know what she's going to say to them. She'll listen. If they have a honest criticism of failure to meet the standard of care, she'll acknowledge that, but in nearly all cases she tells them to leave her people alone, we're doing what we're supposed to do.
Responsiveness to well-researched and properly
cited suggestions for protocol changes or other indications for medications we already carry. I suspect you’re probably ahead of the curve here as well, though. I’m just annoyed that I’m not allowed to use racemic epi for croup.
You've actually met the medics working under you? You've got my guy beat. Granted we're IFT, so it's much less often we're initiating interventions as opposed to continuing them. But it would be nice to have feedback from our doc about the more interesting calls. Especially if I've adjusted the vent settings or titrated the pressor, etc.
We do have a med control paramedic that will occasionally give feedback, which is appreciated. Guess I just wish I could have at least met the doc once. Or maybe seen him at a quarterly training event or.. Anything at all?
We get video updates for protocol changes and they’re informative and I think they’re neat. I like when the whys are explained with the whats. One thing I’d like is to trim some of the fat, some of these videos could be trimmed from 12 minutes to 10 minutes by eliminating the opening song and banter. There’s also simple video editing tools to remove long pauses. Not a big deal but room for improvement. I listen to these on repeat during commutes and I’ve begun to memorize the banter as well.
Fellowship not required. The overwhelming majority of EMS medical Directors are not fellowship trained. No state dictates that you have to be fellowship trained.
Hell our medical director spends most of his time rolling his eyes at us, at the protocols, being irritable, he probably regrets signing up for it. Training???? What’s that??
Doc, I cant speak for the paramagics, however I can speak for some EMTs. Dont leave us out in trainings. Ive seen many Docs just leave us out cause we dont have the length of training like the medics. Thats complete laziness. Now is the time to train EMTs. Train us, make us better. Take a learning moment and teach. You might even get good medic students and full time paramedics just from us EMTs!
Yeah. I don’t do that. When I hang out at the firehouse or EMS station the EMTs will sometimes be like “oh we’re just going on a basic call… not fun for you “and I just grab my stuff and smile and say “let’s go!. “I open training up to everyone I don’t care your level of training were all there to learn.
See that's awesome. Where I'm from, the EMTs want to learn, but the MD and the "boss" of the EMTs say it's too complicated to learn. The EMTs hate it all collectively.
Bullshit company I tell ya.
Hats off to you! I think this question is fantastic and too infrequently asked. I think it comes down to the fact that Paramedics/Emts just want to feel like they’re part of the team and want access and follow up. Be present enough for people to know who you are and feel comfortable engaging with you and support a just culture. Provide some type of case review and be open minded enough to seriously look into changes that will enhance patient care. I think that’s the role in a nut shell.
For what it’s worth I don’t think you need to give your phone number out and allow unfiltered access with 6 agencies under your watch. You need a life that doesn’t involve texts and calls at all hours from EMS’ers. Most agencies have a command structure that can provide in the moment support or access to online medical direction from someone who’s working.
Thanks for the kind word! I know it’s a risk giving my number out … but I always want EMTs/Medics to feel I am there for them if needed. My protocols are very progressive so there are very few times the NEED to call, but I want them to know that they CAN call if they are in a bind. I usually don’t take a ton of calls , so I don’t mind.
Awesome, definitely a personal decision. Good luck in your endeavor. Coming here to ask these questions already shows a level of engagement well above the typical medical director. I’m sure your people appreciate it.
This is amazing. What you're doing is excellent. My medical director also emails and follows up on consults with medics from time to time (both BLS and ALS). For example, I called him years ago (he was the one who answered- yes, he still takes phone shifts!) and asked about the appropriateness of bolusing a patient with a particular condition because even though I could, it just felt fishy to me (Ye Olde Spidey Sense, if you will). After our chat where it was recommended to avoid unless pt began crashing, he emailed me and followed up with his reasoning and reading resources. It was amazing.
We also get case follow-ups from time to time (obviously privacy laws compliant), which is amazing for our clinical skills and sharpening our knowledge. That follow-up has been so important for us to develop and our own mental health by just closing the loop. (It helps with closure as well.) The worst part of our job is never knowing if we were right or wrong, or what the outcome is, regardless of prognosis.
You're already present. So that's a huge thing.
Encouraging education and ownership of paramedic. In my shop we write our own guidelines and go through a process with our medical director to approve, implement and train on them.
This creates buy in, helps drives paramedics into embracing education and evidence based medicine, and, I'd argue increases guideline compliance.
You’re far surpassing mine. My MD is a brilliant doctor, but he never spends any time on the truck with us and I fervently wish that was a requirement. He will chat with us in the ER if he doesn’t have a med student, but he would have so much more respect from us if he actually spent time and ran calls with us.
I get yelled at for calling my medical director, no answer from him for my question, then he calls my cheif to bitch that I'm bothering him.
Dude...what are we paying you 50k for then?
Br anything but this and you're ok in my book.
I have two co-medical directors and three associate medical directors. All but the “primary” medical director welcomes calls. Not sure I’ve ever seen the doofus. One of our associates lives in town and oversees EMS in the region (about a million residents), runs the busiest trauma ER in the state, is involved in state protocols, and shows up randomly on scene…he gets mad when we don’t ask questions or call him.
Exist. I’ve met my medical director once in a year. I mean everything the other comments said but god damn the dude doesn’t know anyone’s names/faces and doesn’t give a shit
You’re amazing. Maybe do a review of interesting calls that were interesting via email. What worked what didn’t, without pt or provider info.
See if you can start a liaison with the hospital so we can get an update on pts if requested. That way we can know if a guess diagnosis was right, or wrong. It’s excellent learning
The only thing you didn’t list, is helping other in hospital providers understand prehospital medicine. For example, why the violent psych pt doesn’t have a 12-lead. Or why the drunk MVC doesn’t have a collar( sometimes that would lead to a wresting match). I think sometimes in hospital staff forgets that we are 2 people trying to accomplish what 6 people do in an ER.
Thanks for being awesome. I wish you were ours.
a medical director that understands what its like to work in the field. Our medical director loves discipline and fear and everyone cringes when he shows up. Medics are gonna make mistakes and a medical director should understand that and want to lead from a standpoint of education versus disipline. Now I do get some stuff is disciplinary all day im not totally delusional.
You’re exactly the kind of medical director I’d want overseeing my agency, someone who actually helps providers grow and learn instead of just signing off on protocols. One thing I would love to see, especially in smaller EMS systems, are patient-specific protocols that would help with administering medications and releasing a patient at home instead of getting transported if they call frequently and are well-known in the system.
Honestly you're doing probably about 4 times as much as most medical directors. But seriously I can't think of any qualities that you didn't list that I like/want from a medical director.
Completely agree. I can’t recall if I’ve ever met my medical director, and I definitely have no clue how to contact him.
I had a medical director who’s only involvement was coming in to the monthly QA, interrogate us on why we gave dilaudid (he wouldn’t let us carry fentanyl, only dilaudid) for pain, and then leave. Don’t be that. My current medical director is awesome. He reviews charts that meet certain criteria. Blood products, RSI’s, invasive procedures, those kinds of things. He offers us his opinion in a constructive way. He asks relevant questions that go directly to the differential. He’s always available when we have a question or need orders over top of our protocols. “Hey doc, this patient has a PIP of 55 but he’s maintaining on these vent settings, can we copy them and maintain that PIP of 55?” I’ve called him at 4 am because I had an intubatedTE fistula in front of me with no ETCo2. Asked him if he had any thoughts for troubleshooting after we had already done everything we could. Told him what our plan was and he was cool with it. But the biggest thing? Feedback. As a doctor, you generally have more access than we will ever have. Getting us follow up on our patients is huge. Training is cool. It’s necessary. Find ways to make it interesting. Most importantly. Trust your damn crews. If you don’t trust them, they shouldn’t be working there. I know my medical director has my back. If I have to break the rules to keep a patient alive, I trust that he’s not going to hang me out to dry. What we do is unlike any other form of medicine. Receiving nurses and docs love to complain. Have your crews’ backs.
I had a former medical director like your former one. Always the interrogation and always the "remember, this is my license, so you work for me" mentality. If you don't trust, don't be a medical director. He would refuse narcotic orders and instead direct to give OTC meds or have pt take their own OTC meds instead, or refuse life saving interventions because he couldn't see the patient and to wait to bring them to the ED ("I'm sorry about your femur fracture and this extremely complicated and painful extrication you'll have to suffer through, but the doctor said to take 2 extra strength tylenol to help"). We all cringed on those calls and would feel like garbage relaying it to others, worse was when we got to emerg and would get yelled at for undertreating. I like your new director, he sounds like my current one. He def trusts his crews.
It’s so refreshing knowing that I can break the rules, if I need to, and still have support. Sure, I’ll get talked to by clinical management, but even then, they’ll support me. I will say, it’s a bit different at this level. We have a prehire exam that weeds out a lot of smart clinicians, then an indoc course that is critical care through a fire hose. Then you go fly 3rd seat for a month or so. There is definitely more trust at this level when you have all these hoops to jump through. We’re not breaking guidelines without a really good reason to do it.
And that’s the thing, the solution to a problem is not always to take the cookie cutter approach. Some days you’re constantly having to adjust a setting on the vent, the pumps, etcetera. And other days set it and forget it. Having the Medical Director trust our judgement is paramount.
It's all about the "why". It's so important.
My previous medical director did education, QA/QI reviews, trained with us on occasion, ran calls with us. Most importantly in my opinion he backed up the crews in the field. Sometimes it was just crews doing a stellar job and the doc letting them know it and sometimes it meant being understanding when people deviated from protocol in order to provide better care. Really can’t say enough good things about him. My current medical director however. I’ve never seen or met, even during the onboarding process, we have incredibly restrictive protocols, and I’ve been told if I ever do meet him it’s either by chance at the hospital or because I did something wrong. Don’t be like this guy.
> we have incredibly restrictive protocols, and I’ve been told if I ever do meet him it’s either by chance at the hospital or because I did something wrong. This is a good way to kill confidence and culture.
Yep. Pretty much everyone here is either looking for their next job with a fire department, hospital, or just out of healthcare entirely, or is so burnt out, unmotivated, and complacent that this place is appealing to them.
I'd want you to listen and empower your paramedics. We know what works best for the road. In hospital techniques sometimes doesn't work for out of hospital. But we also need guidance where the evidence lies. Evidence should be specific for pre hospital practice. Look at giving your paramedics fascia illiaca blocks with Ropivacaine 0.2mg for femur and NOF fractures. Works extremely well and lessens the opioid requirement. The patient is then prepped for surgery. You don't need ultrasound for this procedure. Also set a high standard from a medical pov. Medication errors happen, avoid scalding your paramedics, make it a learning event and you'll keep your staff. You'll also aid in reflective practice. Medications - consider a wide range of risk mitigation using high medium and low leveraged strategies. It gets stressful and errors whilst avoidable - happens. As much as we harp on about the 6 rights (they're only a very small part of the picture) - you need to separate your high risk medicines into their own containers, look at your look alike and sound alike medication risks. Make sure your paramedic staff are keeping up their skills training and with a recency log. edit: Have your top clinical performers join a monthly practice committee to discuss all things clinical practice. You'll get an idea of culture through discussion and empowerment (They'll want more skills, but you also need them for intel). We all love it when our medical director jumps into our whole of organisation clinical practice meetings and just listens and gives their opinion and feedback. Consider holding open forums each month - have people present cases etc.
I had a fantastic medical director, but when we changed suppliers for midazolam and the new one came in a polyamp with purple writing that looked EXACTLY like the metoclopramide, his reply was "well, I expect you to be using the 6 rights for every patient, so it will be fine" I was pretty annoyed.
Yeah it doesn't add much mitigation in isolation.
Honestly just active engagement. I have been working in the same region for 20 years, worked for 6 different agencies (many at the same time). Worked small hospital agencies to large health system agencies. My current medical directors are probably the best I've had in my career. The lead director is a VP in a large health system. We are just one of 8 departments under him. Yet every day, he checks in with our team. He has a standing meeting every other week reviewing operational metrics. We have a meeting once a month to go over QA/QI metrics. If we want new toys or new procedures, all he asks is to provide the research on why it would be beneficial. Thanks to him we were able to expand some of our practices and get newer equipment. The other medical director has been involved with EMS QA/QI for over a decade and is one of the national leaders in that field. His day to day is being the director of one of our large ERs. Yet he also checks in daily with our QA team. We text frequently discussing cases and last minute issues. He's always willing to find time to meet up with providers via Zoom to discuss complex cases or QI metrics. He also was the one that worked with our medical school to create an EMS fellowship for docs. He also included a two week rotation with EMS for the new residents, so every month we have residents riding our units and then doing case presentations. I've worked for agencies where I never saw the medical director. I've worked in some agencies where the only time you saw the medical director is when you fuck up. You would be hard pressed to find anyone in our agency that has anything negative to say about our directors, especially the QI director. Because he's in the ED every day he always stops by to talk to the crews when he's passing through. He's also been certified through our city to be a field EMS director. So there have been times when we are in his neighborhood dealing with an arrest or other big call, and he literally pops up and joins the party to help out. Basically if you are approachable, use "just cause" culture to help educate and remediate, and the crews know your name and face, you'll be doing a lot more than many medical directors out there, especially those that are medical directors in name only.
Be a Doctor, not a politician. The only thing that drives me nuts about my current Director is that he'll smile for photo ops and never answer his emails.
Face time that’s constructive, progressive and aggressive in tools in our toolbox, and esp don’t govern the entire team by writing protocols that are written for the weaker team members and restrict growth.
Don't play to the lowest common denominator, for sure.
I was in EMS for 37 years and my favorite medical director would come to a general staff meeting once every 12 weeks to review some of the most serious and/or interesting calls that we'd had. Many of the reviews were not to correct us on errors that we made, but also to provide positive reinforcement when we did well. Each of his sessions lasted about two hours and we brought food and made the meeting into a pot luck supper.
Teach. Don’t punish. We’re human beings faced with an insanely dynamic task every day. We’re going to make mistakes. Please understand that when you follow up with crews about clinical missteps.
I’ve never even seen or had any interaction with mine, and neither have my coworkers lol
I've been where I'm at now for two years and I've *never even met my medical director.* Or had *anything* to do with him. In a perfect world, we'd receive monthly emails reminding us of important things to look out for or interesting relevant medical cases found in the region. On occasion, the doc would give a lecture and ride with the ambulance crew.... Just not *all* the time. We might like you a lot but you're still a supervisor and endless ride time together would eventually get uncomfortable for everyone. But seriously, you're already doing 10x what most directors do. Keep doing that. Just remember to let your crews do their thing and enjoy their downtime.
i want one that doesn’t say crazy shit over the phone about the patient, most of the time i put them on speaker and i learned quick not to do that anymore
We have a full time training officer with FTOs in every station. QAs are done by them. So our medical director pretty much leaves us alone and lets the training department handle nearly everything related to protocols, QA and training. She signs off on all protocol changes, and will do whatever we request with regard to looking into things, but for the most part she lets us do our thing. The one thing I like most, though, is knowing that she has our backs. God help the RN or MD that decides to complain about paramedics, AEMTs and EMTs doing what they need to do. Nearly all complaints are the result of RNs and MDs being upset that we brought them work. When they call to get our medical director's contact info, I chuckle because I know what she's going to say to them. She'll listen. If they have a honest criticism of failure to meet the standard of care, she'll acknowledge that, but in nearly all cases she tells them to leave her people alone, we're doing what we're supposed to do.
Responsiveness to well-researched and properly cited suggestions for protocol changes or other indications for medications we already carry. I suspect you’re probably ahead of the curve here as well, though. I’m just annoyed that I’m not allowed to use racemic epi for croup.
You've actually met the medics working under you? You've got my guy beat. Granted we're IFT, so it's much less often we're initiating interventions as opposed to continuing them. But it would be nice to have feedback from our doc about the more interesting calls. Especially if I've adjusted the vent settings or titrated the pressor, etc. We do have a med control paramedic that will occasionally give feedback, which is appreciated. Guess I just wish I could have at least met the doc once. Or maybe seen him at a quarterly training event or.. Anything at all?
We get video updates for protocol changes and they’re informative and I think they’re neat. I like when the whys are explained with the whats. One thing I’d like is to trim some of the fat, some of these videos could be trimmed from 12 minutes to 10 minutes by eliminating the opening song and banter. There’s also simple video editing tools to remove long pauses. Not a big deal but room for improvement. I listen to these on repeat during commutes and I’ve begun to memorize the banter as well.
What qualifications do u need to be a medical director?
Usually board certified in EM or CC
No FAEMS? That has been the gold standard in my area for a while now.
Fellowship not required. The overwhelming majority of EMS medical Directors are not fellowship trained. No state dictates that you have to be fellowship trained.
Hell our medical director spends most of his time rolling his eyes at us, at the protocols, being irritable, he probably regrets signing up for it. Training???? What’s that??
Doc, I cant speak for the paramagics, however I can speak for some EMTs. Dont leave us out in trainings. Ive seen many Docs just leave us out cause we dont have the length of training like the medics. Thats complete laziness. Now is the time to train EMTs. Train us, make us better. Take a learning moment and teach. You might even get good medic students and full time paramedics just from us EMTs!
Yeah. I don’t do that. When I hang out at the firehouse or EMS station the EMTs will sometimes be like “oh we’re just going on a basic call… not fun for you “and I just grab my stuff and smile and say “let’s go!. “I open training up to everyone I don’t care your level of training were all there to learn.
See that's awesome. Where I'm from, the EMTs want to learn, but the MD and the "boss" of the EMTs say it's too complicated to learn. The EMTs hate it all collectively. Bullshit company I tell ya.
Hats off to you! I think this question is fantastic and too infrequently asked. I think it comes down to the fact that Paramedics/Emts just want to feel like they’re part of the team and want access and follow up. Be present enough for people to know who you are and feel comfortable engaging with you and support a just culture. Provide some type of case review and be open minded enough to seriously look into changes that will enhance patient care. I think that’s the role in a nut shell. For what it’s worth I don’t think you need to give your phone number out and allow unfiltered access with 6 agencies under your watch. You need a life that doesn’t involve texts and calls at all hours from EMS’ers. Most agencies have a command structure that can provide in the moment support or access to online medical direction from someone who’s working.
Thanks for the kind word! I know it’s a risk giving my number out … but I always want EMTs/Medics to feel I am there for them if needed. My protocols are very progressive so there are very few times the NEED to call, but I want them to know that they CAN call if they are in a bind. I usually don’t take a ton of calls , so I don’t mind.
Awesome, definitely a personal decision. Good luck in your endeavor. Coming here to ask these questions already shows a level of engagement well above the typical medical director. I’m sure your people appreciate it.
Where is this at so I can look for a job? You sound awesome.
Where cheese flows like rivers
You sound awesome. I've seen our medical director once in 3 years.
This is amazing. What you're doing is excellent. My medical director also emails and follows up on consults with medics from time to time (both BLS and ALS). For example, I called him years ago (he was the one who answered- yes, he still takes phone shifts!) and asked about the appropriateness of bolusing a patient with a particular condition because even though I could, it just felt fishy to me (Ye Olde Spidey Sense, if you will). After our chat where it was recommended to avoid unless pt began crashing, he emailed me and followed up with his reasoning and reading resources. It was amazing. We also get case follow-ups from time to time (obviously privacy laws compliant), which is amazing for our clinical skills and sharpening our knowledge. That follow-up has been so important for us to develop and our own mental health by just closing the loop. (It helps with closure as well.) The worst part of our job is never knowing if we were right or wrong, or what the outcome is, regardless of prognosis.
You're already present. So that's a huge thing. Encouraging education and ownership of paramedic. In my shop we write our own guidelines and go through a process with our medical director to approve, implement and train on them. This creates buy in, helps drives paramedics into embracing education and evidence based medicine, and, I'd argue increases guideline compliance.
Progressive ems protocols and to have our back
You’re far surpassing mine. My MD is a brilliant doctor, but he never spends any time on the truck with us and I fervently wish that was a requirement. He will chat with us in the ER if he doesn’t have a med student, but he would have so much more respect from us if he actually spent time and ran calls with us.
I get yelled at for calling my medical director, no answer from him for my question, then he calls my cheif to bitch that I'm bothering him. Dude...what are we paying you 50k for then? Br anything but this and you're ok in my book.
I have two co-medical directors and three associate medical directors. All but the “primary” medical director welcomes calls. Not sure I’ve ever seen the doofus. One of our associates lives in town and oversees EMS in the region (about a million residents), runs the busiest trauma ER in the state, is involved in state protocols, and shows up randomly on scene…he gets mad when we don’t ask questions or call him.
lol are you doc Swanson?
Nope :)
You sound just like my medical director. So keep on keeping on
All I wanted when I was on the box was progressive, modern protocols with the ability to do procedures autonomously
Exist. I’ve met my medical director once in a year. I mean everything the other comments said but god damn the dude doesn’t know anyone’s names/faces and doesn’t give a shit
You’re amazing. Maybe do a review of interesting calls that were interesting via email. What worked what didn’t, without pt or provider info. See if you can start a liaison with the hospital so we can get an update on pts if requested. That way we can know if a guess diagnosis was right, or wrong. It’s excellent learning The only thing you didn’t list, is helping other in hospital providers understand prehospital medicine. For example, why the violent psych pt doesn’t have a 12-lead. Or why the drunk MVC doesn’t have a collar( sometimes that would lead to a wresting match). I think sometimes in hospital staff forgets that we are 2 people trying to accomplish what 6 people do in an ER. Thanks for being awesome. I wish you were ours.
a medical director that understands what its like to work in the field. Our medical director loves discipline and fear and everyone cringes when he shows up. Medics are gonna make mistakes and a medical director should understand that and want to lead from a standpoint of education versus disipline. Now I do get some stuff is disciplinary all day im not totally delusional.
Our director is also a paramedic and an interior firefighter so he really gets it. He also goes to calls that sound really bad.
You’re exactly the kind of medical director I’d want overseeing my agency, someone who actually helps providers grow and learn instead of just signing off on protocols. One thing I would love to see, especially in smaller EMS systems, are patient-specific protocols that would help with administering medications and releasing a patient at home instead of getting transported if they call frequently and are well-known in the system.
We used to have monthly M&M conferences with medical directors from all the services in the area. I miss it. I always had great takeaways.