# BLS Medical Director Interaction



## EpiEMS (Feb 25, 2015)

Very curious to hear how much/little BLS providers have with their service's medical director -- I, for one, have met mine once, but only in passing, and this is on an ALS service. what do you feel is the appropriate level of BLS providers/medical director level of interaction?


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## NomadicMedic (Feb 25, 2015)

I think an annual CE session, with the medical director setting up his expectations for BLS, is probably more than enough. Really, the medical director shouldn't have to be intimately involved with a BLS service, unless he's overseeing remediation for QI issues. 

However, I think medical directors should be involved in training and oversight for ALS providers. (But that's a whole 'nother topic)


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## Ewok Jerky (Feb 25, 2015)

Very little. Medical directors have better things to do than teach BLS to peeps who should already know it. Even ALS, maybe a yearly get together, or occasional in-service for protocol changes. Medical directors should be more interactive with upper management making sure that the right indivudals are able to do there job and create a functional hierarchy.


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## RedAirplane (Feb 26, 2015)

In my non-traditional first response role in college, my medical director was my primary care doctor as well as that of most of the students. He also ran the clinic on campus.


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## Chewy20 (Feb 26, 2015)

We see ours all the time at CE and in the ED when hes working his rounds.


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## DesertMedic66 (Feb 26, 2015)

It's not practical for us to meet with our medical director. Usually are medical directors are currently working in an ED somewhere. Since we use a county wide medical director, he would have to meet with a lot of providers (rough guess would be around 1,000).

However he does do some CE classes. As for protocol up dates we due what's called train the trainer (our FTOs get trained by the county EMS people who in turn train us).


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## Tigger (Feb 26, 2015)

One of our three doctors comes up once a month for case review. Those are my favorite sort of CE, especially since they have access to the hospital EMR so we can get a followup on interesting patients beyond someone's vague recollection.


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## cfd3091 (Feb 26, 2015)

He often stops by various stations just to talk and provide some insight on things. He is an excellent teacher. He makes up scenarios and asks what you would do to handle this patient.  Of course they are mostly ALS type interventions but not always. Sometimes he seeing if you know when to keep it simple. He actually was at the station I was working today. We learned a lot.


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## Underoath87 (Feb 28, 2015)

As everyone stated, medical directors shouldn't be preoccupied with BLS matters.  Per my former managers, a medical director isn't even needed for BLS services in Florida (I haven't bothered to look that one up).


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## BlueJayMedic (Feb 28, 2015)

We have a base hospital program that encapsulates about 10 services and has 12+ docs that can be reached by calling our base hospital patch number. We have annual service training sessions that give BLS providers their 8 hours mandatory CME credit and ALS 8 of their 24 total yearly CME required hours. We meet the head of the program once on initial certification if we're lucky and we will get her on the phone every now and then when we call. During the day the call directs to whatever doc is on via their cell and after hours goes to whatever ED doc that is working the trauma centre in the middle of the coverage area. We get a base hospital doc number at the end of the call for documentation and 9 times out of 10 we don't even get a name.


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## Eleventy7 (Feb 28, 2015)

Our medical director goes over protocols with my boss every year. I talked to him once about meatloaf during my orientation before I knew who he was. Follow protocol, provide great patient care, and you really don't need more interaction than that. If we're really lost the ER doc is only a phone call away.


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## Tigger (Mar 1, 2015)

Our medical director also occasionally responds to calls when he is bored and hears sirens. He throws a sharpied "medical director" traffic vest on and then provides on scene orders for maximal pain relief.


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## RedAirplane (Mar 1, 2015)

Tigger said:


> Our medical director also occasionally responds to calls when he is bored and hears sirens. He throws a sharpied "medical director" traffic vest on and then provides on scene orders for maximal pain relief.



That's awesome.


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## NomadicMedic (Mar 1, 2015)

Tigger said:


> Our medical director also occasionally responds to calls when he is bored and hears sirens. He throws a sharpied "*CANDY MAN*" traffic vest on and then provides on scene orders for maximal pain relief.



Fixed that for you.


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## Tigger (Mar 1, 2015)

DEmedic said:


> Fixed that for you.


Troof. I'm still waiting for him to do a chest tube in the back, it's going to happen.


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## ERDoc (Mar 2, 2015)

I think a lot of it just depends on the size of your system and how it is set up.  I came through the volley system in Suffolk County, NY.  Our county medical director was responsible for something like 101 agencies (VACs and FDs) with a couple thousand EMTs and several hundred ALS providers.  It's not really a set up for much hands on interaction.  After I left the system they started carrying narcs and from what I understand, each agency has to have it's own medical director to oversee the narc program and each medical director can only oversee 5 agencies.  I would imagine at that point it just depends on the doc.


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## samiam (Mar 2, 2015)

At one of the systems I was at, they had ER residents do a 3 month rotation as the Medical Control Person and they had a fly car to respond to bigger calls or just when they were bored. It was also setup for MCI's with a really cool oxygen snake with like 20 attachments. It also had a bunch of cool advanced stuff in it.
*Edit: They actually were required to 4 non MCI/Trauma/Cardiac Arrest calls per 24 hr shift so they could build a better rapport with the medics. All of the EM residents also do a "grand rounds" twice a year where they suit up and learn how to use all of the EMS/Fire equipment.


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## Eleventy7 (Mar 2, 2015)

samiam said:


> *Edit: They actually were required to 4 non MCI/Trauma/Cardiac Arrest calls per 24 hr shift so they could build a better rapport with the medics. All of the EM residents also do a "grand rounds" twice a year where they suit up and learn how to use all of the EMS/Fire equipment.


Love it.


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## Nightmare (Mar 4, 2015)

samiam said:


> At one of the systems I was at, they had ER residents do a 3 month rotation as the Medical Control Person and they had a fly car to respond to bigger calls or just when they were bored. It was also setup for MCI's with a really cool oxygen snake with like 20 attachments. It also had a bunch of cool advanced stuff in it.
> *Edit: They actually were required to 4 non MCI/Trauma/Cardiac Arrest calls per 24 hr shift so they could build a better rapport with the medics. All of the EM residents also do a "grand rounds" twice a year where they suit up and learn how to use all of the EMS/Fire equipment.



where do you work? i wanna work there!


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## samiam (Mar 4, 2015)

Nightmare said:


> where do you work? i wanna work there!


 You would have to move to Michigan!


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## Akulahawk (Mar 4, 2015)

None of the places I've ever worked have I actually _met_ the Medical Director. The BLS company I worked for needed him because we occasionally needed to order certain medical supplies and drugs for the CCT program. I don't think there was anything (except _maybe _for medical grade oxygen) that required his approval for the BLS side. One of the companies I worked for had a Medical Director that provided us a protocol that would allow us to transport patients that had potassium up to 20 mEq/L in a running IV bag. At the time, no other local company was allowed to do that.


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## Sentinel641 (Mar 6, 2015)

samiam said:


> You would have to move to Michigan!



Do you work at U of M by any chance?


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## ZombieEMT (Mar 11, 2015)

I have to say at my volunteer squad (which also has a career division), we have a very active medical director. Our medical director is active in all policies/procedures and does a lot of Q/A. We get a ton of feedback on charting. He is also a very visible medical director. We see him regularly on meetings and occasionally does ride along. I do not think having a medical direction that is this active is a bad thing, it is great. It is as important as for an ALS provider. BLS providers can make mistakes or bad judgement just like and ALS provider would. Not any EMT or Paramedic is perfect.


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## Flying (Mar 11, 2015)

ZombieEMT said:


> I have to say at my volunteer squad (which also has a career division), we have a very active medical director. Our medical director is active in all policies/procedures and does a lot of Q/A. We get a ton of feedback on charting. He is also a very visible medical director. We see him regularly on meetings and occasionally does ride along. I do not think having a medical direction that is this active is a bad thing, it is great. It is as important as for an ALS provider. BLS providers can make mistakes or bad judgement just like and ALS provider would. Not any EMT or Paramedic is perfect.


Dr. Lavelle by any chance? He seems to have built a small empire throughout PA/NJ.


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## samiam (Mar 11, 2015)

Sentinel641 said:


> Do you work at U of M by any chance?


 Nope 

http://med.wmich.edu/node/912


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## Sentinel641 (Mar 13, 2015)

Just the ability to interact that much with MCA Director really makes me want to move out there and apply for EMS jobs..


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## samsbgm (Mar 17, 2015)

EpiEMS said:


> Very curious to hear how much/little BLS providers have with their service's medical director -- I, for one, have met mine once, but only in passing, and this is on an ALS service. what do you feel is the appropriate level of BLS providers/medical director level of interaction?


We had to test with our medical directors. We often are giving room reports to our medical directors. Ours are pretty awesome and will support you.


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## Sentinel641 (Mar 17, 2015)

samsbgm said:


> We had to test with our medical directors. We often are giving room reports to our medical directors. Ours are pretty awesome and will support you.



By "test" do you mean that you had to take practicals, or written tests? I'm a little confused. But regardless, I believe that interaction with your MedDir makes the EMS team work so much better.


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## Tigger (Mar 17, 2015)

I test with our medical directors every year, as does every employee (both part and full time). It's a practical scenario where you are paired with a paramedic. At different junctures the physician will state that a certain ALS intervention is not working and then will ask the EMT to provide something within his scope (i.e. supraglottic airway when the patient cannot be intubated, monitor fails and can only be used as an AED, that sort of thing).


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## samsbgm (Mar 27, 2015)

Sentinel641 said:


> By "test" do you mean that you had to take practicals, or written tests? I'm a little confused. But regardless, I believe that interaction with your MedDir makes the EMS team work so much better.


We did a practical with our medical directors to be able to be on the streets. All the written test were given to us by the company.


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## gotbeerz001 (Mar 27, 2015)

A practical WITH the MedDir? You must have a tiny system.


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## samsbgm (Mar 27, 2015)

gotshirtz001 said:


> A practical WITH the MedDir? You must have a tiny system.


I wouldn't call it tiny but it's not the biggest. We Only run 100,000 calls a year.


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## gotbeerz001 (Mar 27, 2015)

samsbgm said:


> I wouldn't call it tiny but it's not the biggest. We Only run 100,000 calls a year.


Well that is pretty impressive that he takes the time to meet every provider working in the system. With our system, both in regards to size and turnover, that would be all our director does.


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## Tigger (Mar 27, 2015)

gotshirtz001 said:


> A practical WITH the MedDir? You must have a tiny system.


My old medical director had 50,000 plus calls a year that he lorded over. You tested with him and him only every year, medics and EMTs.


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## samsbgm (Mar 27, 2015)

gotshirtz001 said:


> Well that is pretty impressive that he takes the time to meet every provider working in the system. With our system, both in regards to size and turnover, that would be all our director does.


We do have a team of 5 medical directors. That helps with testing. Not everyone tests with the same medical director.


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