EMS System Leadership and Quality Improvement

1. You Don't Have an Independent License

Start here, because it changes how you read everything else in this lesson.
You don't practice medicine on your own authority. You practice under a
physician medical director. Every skill you perform, every drug you push,
traces back to that physician.

That authority comes in two forms.

On-line medical direction is direct. It's real-time contact with a
physician for orders or consultation on the patient in front of you. You call,
you describe, the doctor gives an order.

Off-line medical direction is indirect. It's everything set up before the
call and reviewed after it. Off-line direction splits again:

Prospective — protocol development, training, and personnel and
equipment selection. This happens before you ever touch a patient.
Retrospective — chart review, quality improvement, case audit. This
happens after the call is over.

So off-line direction is the authority that surrounds the call on both sides,
and on-line direction is the authority that's live during it.

The medical director's job is bigger than signing protocols. It includes
education and training of personnel. Participation in personnel and equipment
selection. Development of clinical protocols. Participation in QI and problem
resolution. Direct input into patient care. And advocacy for EMS within the
medical community.

Credentialing is the term the exam wants you to pin down precisely.
Credentialing is a clinical determination made by the physician medical
director that authorizes a specific practitioner to perform a specific skill
or role. That's different from certification and licensure. You can be
nationally certified and state licensed and still not be credentialed to
perform a given skill at a given agency. That's because credentialing is
local and clinical. It's not a card you carry from state to state.