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 offic ers-field supervisors of 211 urban advanced life support (ALS) service s in the United States. The survey also requested information about me dications carried, approved procedures, and who set these standards. R espondents also rated the EMS medical director's involvement in variou s activities (quality assurance, administrative, executive, run review s, and inservice/education). Results: Eighty-five percent (n = 179) of the forms were returned, with 165 (78%) usable. The physician EMS med ical directors were primarily trained in emergency medicine (77%) and were paid (75%) for EMS responsibilities. The number of medications ca rried and the number of approved procedures were not related to either the number of hours the physicians commit weekly to the EMS service o r their degree of involvement in ALS activities. The physician EMS med ical directors were most often involved in quality assurance and educa tion and were less likely to devote time to executive or other adminis trative functions of ALS units, with the exception of fire-based EMS p hysician medical directors, who contributed significantly to executive and administrative functions (p < 0.05). Overall practice standards w ere established by the medical director (46%), the state department of health (24%), and local/regional health authorities (23%). Conclusion s: EMS training officers believe that urban ALS medical directors in t he United States primarily provide quality assurance and educational s upport. With the exception of fire-based EMS systems, physicians appea r to have limited involvement in other EMS administrative and executiv e functions.