Medical direction and medical control of air medical services:☆

Article Outline

• Medical direction
  • Responsibility and authority of the medical director
  • Qualifications of the medical director
  • Obligations of the Air medical service
• Medical control
  • Method of medical control
  • Responsibility and authority for medical control
    • Interhospital patient transfers
    • Prehospital patient transfers

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Medical direction 

The Air Medical Physician Association believes that all air medical services require the active involvement and participation of a physician medical director(s) who shall be responsible for supervising, evaluating, and ensuring the quality of medical care provided by the air medical transport team.

At all times, medical direction must be consistent with the following priorities. Safety of the crew, patient, and vehicle must always be the first priority. The second priority is the provision of appropriate patient care. Finally, after addressing safety and patient care, medical direction should be committed to the appropriate utilization of medical transport resources and cost-effective patient transport.

Responsibility and authority of the medical director 

The medical director of an air medical service shall:

Qualifications of the medical director 

The medical director of an air medical service shall:

Obligations of the Air medical service 

The qualifications, responsibilities, and authority of the medical director should be specified in a written agreement between the physician and the air medical service. The air medical service must empower its medical director with the authority and necessary resources commensurate with the responsibilities identified, which should include:

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Medical control 

The Air Medical Physician Association believes that all air medical transports require physician medical control and that the responsibility for ensuring appropriate medical control rests with the medical director(s) of the air medical service.

The medical director has the final authority over all patient care aspects of the air medical service, which include medical control for all transports. The medical director, however, may delegate the responsibility and authority for medical control to other qualified individuals.

The medical director is responsible for selecting, orienting, and ensuring the competency of any medical control physician. Orientation activities shall include review of the policies, procedures, patient care protocols, and in-flight patient care capabilities and limitations of the air medical service.

Appropriate medical control must take into consideration the medical care requirements of the individual patient and a thorough knowledge of the scope of care that can be provided by the air medical transport team. The scope of care for each air medical service is based on the patient care capabilities of the transport personnel, available medical equipment, formulary, and the capabilities and limitations of their transport vehicles.

Medical control physicians must have the experience and knowledge to ensure that appropriate medical control and medical care are rendered and consistent with the scope of practice and the mission of the air medical service. If the experience of the medical control physician in a particular clinical area is insufficient to ensure appropriate care, the medical control physician should seek suitable and timely consultation.

Method of medical control 

Medical control may be accomplished in one of three ways: on-line, off-line, and visually. On-line medical control represents direct, real-time voice communication between the medical control physician and the transport team. During off-line medical control, there is no direct contact between the transport team and the medical control physician. Patient interventions follow written medical protocols or standing orders provided by the medical director, medical control physician, referring physician, or receiving physician. Visual medical control occurs when a medical control physician is physically present during the transport.

Responsibility and authority for medical control 

While medical control for interfacility transfers may be assumed by the transferring physician, receiving physician, or the medical director (or designee) of the air medical service, AMPA believes that medical control should remain the responsibility of the air medical director or his or her designee. Any variation from this standard should be specified in a patient transfer agreement or at the time of request for air medical transport.

While medical control for prehospital transfers may be assumed by the receiving physician, EMS base station, or air medical service medical director (or designee), AMPA believes that medical control should remain the responsibility of the air medical director or his or her designee.