Medical oversight is a cornerstone of prehospital care, yet many EMS agencies operate without full-time medical direction. Instead, they rely on part-time or volunteer physicians whose involvement is often limited to signing off on protocols once a year.
In this episode of the Inside EMS podcast, Dr. David Tan, chief medical officer of St. Charles County Ambulance District, shares how full-time medical directors can fundamentally improve patient care, provider education and system operations.
Why EMS needs full-time medical directors
EMS is more than just transportation — it is a practice of medicine. According to Dr. Tan, EMS providers act as physician surrogates, making critical clinical decisions at the point of illness or injury. “The opportunity to truly impact patient outcomes happens in the field, before the patient ever reaches the hospital,” he says. To ensure quality care, EMS agencies need engaged, accessible and fully integrated medical directors.
Breaking the status quo
A key barrier to full-time medical direction is funding. Many agencies claim they cannot afford a full-time physician on staff. However, as Dr. Tan argues, “Every agency finds money for vehicle maintenance, station upkeep, and equipment — why is medical direction any different?”
Agencies have found creative ways to fund these positions, including:
- Allocating budget resources as they do for other essential staff
- Partnering with hospital systems
- Incorporating clinical practice time into EMS physician roles
- Advocating for legislative funding support, such as NAEMSP’s advocacy for physician medical director compensation
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