Physician medical oversight in emergency medical services: where are we?

The objective of this study was to quantify the amount of direct contact with medical direction that nationally registered emergency medical services (EMS) professionals receive. The secondary objective was to determine whether differences in medical director contact were associated with work-related characteristics.

As part of biennial reregistration paperwork, nationally registered EMS professionals reregistering in 2004 were asked to complete a survey regarding medical direction. There were three survey questions asking participants to indicate, on a five-point scale, how often they interacted with their medical director in specific situations (whether the medical director participated in continuing education, met personally to discuss an EMS issue, and was seen at the scene of an EMS call). Individuals were categorized as having limited contact if they had not observed their medical director in any of the above situations for more than six months. All others where categorized as having recent contact. Demographic characteristics were collected and statistical analysis was performed using chi-square.

In 2004, 45,173 individuals reregistered, with 28,647 (63%) returning surveys. A complete case analysis was performed, leaving 22,026 (49%) individuals. There were 13,756 (62.5%) individuals who reported having recent medical director contact. A stepwise increase in the percentage of those reporting recent contact was present when comparing the providers' certification levels (emergency medical technician EMT-Basic 47.6%, EMT-Intermediate 62.3%, and EMT-Paramedic 78.5%, p < 0.001). The highest percentage of recent contact was reported by those who worked for a hospital-based service, whereas the lowest percentage was reported by volunteer services (hospital-based 78.8%, county/municipal 70.8%, private 67.6%, military 62.4%, government 61.1%, fire-based 57.0%, and volunteer 50.8% chi(2) = 712.4, p < 0.001). EMS professionals working in urban areas were more likely to report recent contact than those in rural areas (64.9% vs. 59.2%, p < 0.001).

It has been suggested that EMS professionals benefit from direct contact with a physician medical director. Nearly one-third of participants in this study reported having limited medical director contact. Certification level, service type, and community size were significantly associated with the amount of contact with medical direction.