Medical Direction

Medical Director Role & Requirements

The medical director of an Ohio EMS agency is a valuable and mandatory asset of an EMS agency. In addition, this physician serves a critical liaison between the local EMS agency, hospital administrators and medical staff, local public health and public safety agencies, and the layperson members of the community.

  • The medical director is required to approve all patient care measures performed by the certified EMS personnel within the EMS agency.
  • The medical director must also provide written protocols that do not exceed the Ohio EMS scope of practice, the regulations for which are determined and approved by the Emergency Medical, Fire, and Transportation Services (EMFTS) Board.
    • The primary goal of the written protocols is to maximize quality patient care and safety and to direct a patient’s triage, treatment, and transport to the most appropriate facility. Ideally, the out-of-hospital patient care measures in the protocols provided to the EMS agency should transition well with those utilized by the medical staff at the receiving facility.
  • The medical director is responsible for the provision of training, continuing education, and quality assurance programs to the EMS agency.
    • As an element of the quality assurance program, the medical director is encouraged to obtain data regarding the EMS agency from the state data registry and the National EMS Information System (NEMSIS) in addition to the review of patient care run reports to identify opportunities for improved patient care delivery.
    • The practice of EMS medicine is dynamic, and the initial and ongoing training of EMS personnel is essential to maintain contemporary patient care measures and EMS provider competency. To facilitate the approval of continuing education at the time of EMS certification renewal, the Division of EMS suggests that the medical director obtain Physician EMS Instructor certification.

The qualifications for a physician to serve as the medical director of an EMS organization are established by the Board in Ohio Administrative Code 4765-3-05. The medical director must:

  1. Be a physician that holds a current, valid license authorizing the practice of medicine and surgery or osteopathic medicine and surgery in Ohio;
  2. Be actively involved in the practice of emergency medicine;
  3. Actively participate with the EMS organization in the conduct of performance improvement programs, educational programs, and protocol establishment and/or updates; 
  4. Demonstrate high ethical standards and no conflicts of interest;
  5. Participate in peer review and quality improvement programs for the EMS organization utilizing aggregate data drawn from the EMS incident reporting system (EMSIRS) and Ohio Trauma Registry (OTR) available from the Division of EMS;
  6. Be board or subspecialty board certified, or board eligible in accordance with OAC 4765-3-05 (A)(6).

If a physician who was not an existing medical director prior to February 1, 2009 and meets all of the minimum qualifications except for number 6 above, the physician should contact the Division of EMS to discuss possible options to obtain a waiver from the Board.

The History of the Path to Becoming a Medical Director of an Ohio EMS Agency

Approved EMS Medical Director Courses

The medical director is encouraged to join the Regional Physician Advisory Board (RPAB) for the region of the physician’s residence or employment. The RPAB is an important liaison between EMFTS Board and local EMS systems and communities. All RPAB meetings are open to the public, and medical directors are invited to attend whether or not they are members.

Although it is not mandatory, the Division of EMS encourages medical directors to consider the designation of an assistant, adjunct, secondary, or co-medical director to ensure seamless provision of medical direction to the EMS agency in the event of an unexpected absence of the primary medical director.

  • An alternate medical director must be a physician who also meets the qualifications in OAC 4765-3-05.
  • Allied health professionals such as nurses, physician assistants, nurse practitioners, or EMS providers cannot serve in this role.
  • With regards to online medical direction, Ohio law allows a physician assistant designated by a physician or a registered nurse designated by a physician to provide verbal orders via a direct communication device with the written or verbal authorization of a physician or a cooperating physician advisory board. (See ORC 4765.35(D)(1), ORC 4765.37(D)(1), ORC 4765.38(C)(1), and ORC 4765.39(C)(1))
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