Medical director

Within emergency medical services a medical director is a physician who provides guidance, leadership, oversight and quality assurance for the practice of local paramedics and EMTs within a predefined area. In North America, medical directors are typically board-certified in emergency medicine. The medical director is generally responsible for either the creation of protocols for treatment by paramedics or providing leadership to the group of physicians who assist with the provision of medical oversight depending on which model of service delivery and which model of medical control are operating. The medical director may also assist the EMS agency in extending its scope of practice. While this definition is a fair description of the role in North America, significant variations can occur in other countries and in other health care systems.

Note: In the interest of clarity, medical directors exist in a variety of other settings in addition to EMS. It is largely a generic term for a physician who has responsibility for the medical control and direction of various types of organizations, including hospital departments, blood banks, clinical teaching services and others. This article focuses specifically on the role of the medical director with respect to the operation of EMS systems.

To understand the role of the medical director in what North Americans call EMS, it is necessary to have a clear understanding of precisely how EMS systems (or ambulance service, SAMU, SMURD, etc.) operate in various locales. There is little about what we call EMS that is universally applicable. Instead, communities and medical practitioners tend to develop systemic arrangements that are based on an assessment of local need. In the delivery of what we commonly refer to as EMS in various countries, there are two major service delivery models, with a number of minor models or variations from the main models. The first model, and arguably the oldest, is generally described as the Franco-German model. This model is physician-led, and places those operating ambulances into what are in many cases, minor, supporting roles. While this model is generally referred to as Franco-German, this may be something of a misnomer, since there is ample evidence and documentation indicating that at the turn of the 20th century, many North American hospital-based ambulances in larger centres were actually staffed by ambulance surgeons; physicians who actually responded in the ambulance and provided care in a manner which very much resembles the current Franco-German model. In the French version of the model, only physicians and nurses perform advanced care, and drivers have only minimal medical training.

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