Tài liệu Handbook for EMS Medical Directors doc

Handbook for

EMS Medical Directors

March 2012

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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.

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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.

Assistant Secretary for Health Affairs and

Chief Medical Officer

Ernest Mitchell, Jr.

U.S. Fire Administrator

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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

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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

Medical Malpractice Coverage ............................................................................................................................. 26

Errors and Omission Coverage............................................................................................................................. 27

General Liability Coverage ................................................................................................................................. 27

Directors’ and Officers’ Coverage .......................................................................................................................... 27

Indemnification............................................................................................................................................... 27

Areas of Caution for Medical Directors ......................................................................................................27

Hiring and Promotional Decisions ....................................................................................................................... 28

Provider Disciplinary Actions.............................................................................................................................. 28

Budget and Procurement Regulations..................................................................................................................... 28

Conflict of Interest Considerations.............................................................................................................28

Agency Oversight..............................................................................................................31

Workforce Oversight and Supervision........................................................................................................31

Provisions of Patient Care...........................................................................................................................32

Protocols........................................................................................................................................................ 32

Standing Orders............................................................................................................................................... 32

Online Medical Direction................................................................................................................................... 33

Offline Medical Direction .................................................................................................................................. 33

Medical Director in the Field......................................................................................................................33

Incident Command System ................................................................................................................................ 34

EMS Scope of Practice ................................................................................................................................35

Education Standards...................................................................................................................................36

National EMS Educational Standards.................................................................................................................... 36

EMS Provider Continuing Education Program Development ....................................................................................... 37

Provider Competency Verification ......................................................................................................................... 38

Performance-Based Organizations..............................................................................................................38

Quality Improvement........................................................................................................................................ 38

Types of Quality Improvement ............................................................................................................................ 40

Six Sigma in EMS............................................................................................................................................ 41

HIPAA and Quality Improvement........................................................................................................................ 42

Performance Measures....................................................................................................................................... 42

Benchmarking................................................................................................................................................. 43

Best Practices.................................................................................................................................................. 44

Ambulance Service Accreditation ......................................................................................................................... 44

EMS Research ................................................................................................................................................. 44

Health and Safety of Medical Directors and Providers................................................................................45

Patient Safety.................................................................................................................................................. 46

Agency Dynamics .............................................................................................................47

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Ambulance Service Certificate of Need .....................................................................................................47

Public Relations .........................................................................................................................................47

Media Inquiries .............................................................................................................................................. 47

EMS Advocacy ................................................................................................................................................ 47

Credentialing in EMS ................................................................................................................................48

EMS Education Program Dynamics ............................................................................................................48

Accreditation of Education Programs .................................................................................................................... 48

Certification of Providers ................................................................................................................................... 49

Recertification of EMS Providers.......................................................................................................................... 50

Agency Compliance Considerations...........................................................................................................51

Collective Bargaining Agreements......................................................................................................................... 51

Right to Work States......................................................................................................................................... 52

Industry Regulations and Standards ...................................................................................................................... 52

Fiscal Management Issues...........................................................................................................................52

Budgeting....................................................................................................................................................... 52

Federal and State Funding Sources ........................................................................................................................ 52

Local Funding Sources....................................................................................................................................... 53

Agency-Level Funding Sources............................................................................................................................. 53

Revenue Recovery Sources ................................................................................................................................... 54

Funding for Medical Directors............................................................................................................................. 54

Apparatus and Equipment..........................................................................................................................54

Ambulance Design ........................................................................................................................................... 54

EMS Equipment and Technology.......................................................................................................................... 54

Medication Supply and Storage Practices................................................................................................................ 55

Moving Forward as a Medical Director............................................................................57

Appendix A: Checklist for the New Medical Director....................................................59

Appendix B: Glossary.......................................................................................................61

Appendix C: EMS Acronyms............................................................................................65

Appendix D: Sample Organization Charts......................................................................67

Appendix E: Sample Affiliation Agreement ....................................................................71

Appendix F: Sample Liability Insurance Form ..............................................................75

Appendix G: Industry Regulations and Standards..........................................................77

Occupational Safety and Health Administration...................................................................................................... 77

National Fire Protection Association..................................................................................................................... 77

American Society for Testing and Materials ............................................................................................................ 78

Appendix H: Performance Measures...............................................................................79

Appendix I: Endnotes ...................................................................................................... 81