A safe and effective EMS system requires considerable physician input and surveillance to provide the best possible care for patients. 4 Medical control can be either on line (immediate and direct) or off line (indirect).
On-line medical control is the provision of direct medical communication to personnel in the field either in person or by radio or phone communication. The EMS medical director delegates this authority to other physicians who understand the protocols under which paramedics administer care. Also, the medical director may allow ambulance personnel to carry out certain standing orders when timely contact with the controlling physician is not feasible.
Off-line medical control is the responsibility of the service medical director. Three main components of off-line medical control are (1) development of protocols, (2) development of medical accountability (quality assurance), and (3) development of ongoing education. Protocol development determines those treatment procedures that prehospital personnel may perform under the medical license of the medical director. Protocols should not only address care but should also specify the utilization of medical devices and equipment. It is the medical director's responsibility to approve the medical devices utilized by EMS personnel. The protocols must be reviewed and rewritten on a regular basis to keep pace with current medical knowledge. Quality assurance requires ongoing surveillance and study of the system. The medical director should enlist other physicians to review existing protocols and suggest improvement where deficiencies are noted. Finally, the medical director is responsible for the ongoing educational needs of the prehospital care providers under his or her direction. The medical director should direct the quality and content of the training. Physicians must remember that they have the ultimate responsibility for the overall quality of prehospital medical care.
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