PHYSICIAN MEDICAL DIRECTION AND ADVANCED LIFE-SUPPORT IN THE UNITED-STATES

Objective: To determine the specialty training and responsibilities of urban U.S, emergency medical service (EMS) medical directors and how these factors relate to the type of service involved (fire, hospital, private, municipal). Methods: A single mailed survey of training officers-field supervisors of 211 urban advanced life support (ALS) services in the United States. The survey also requested information about medications carried, approved procedures, and who set these standards. Respondents also rated the EMS medical director's involvement in various activities (quality assurance, administrative, executive, run reviews, and inservice/education). Results: Eighty-five percent (n = 179) of the forms were returned, with 165 (78%) usable. The physician EMS medical directors were primarily trained in emergency medicine (77%) and were paid (75%) for EMS responsibilities. The number of medications carried and the number of approved procedures were not related to either the number of hours the physicians commit weekly to the EMS service or their degree of involvement in ALS activities. The physician EMS medical directors were most often involved in quality assurance and education and were less likely to devote time to executive or other administrative functions of ALS units, with the exception of fire-based EMS physician medical directors, who contributed significantly to executive and administrative functions (p < 0.05). Overall practice standards were established by the medical director (46%), the state department of health (24%), and local/regional health authorities (23%). Conclusions: EMS training officers believe that urban ALS medical directors in the United States primarily provide quality assurance and educational support. With the exception of fire-based EMS systems, physicians appear to have limited involvement in other EMS administrative and executive functions.