This chapter will provide a framework for understanding the complex and evolving nature of prehospital telemedicine in a practical context. The challenges associated with expanding prehospital telemedicine and the need to address them with innovative funding models, stakeholder buy-in, and a thorough understanding of varying local prehospital systems and their interplay with existing regulatory frameworks are also discussed. In this chapter, the history, development, and sustainability of prehospital telemedicine programs are discussed while highlighting past, current, and possible future applications. Prehospital medicine is rapidly evolving in both scope and purpose with telemedicine providing novel opportunities to offer support and oversight to emergency medical service providers while bringing advanced care to the site of illness or injury. This is one of two studies to examine medical direction from the perspective of paramedics and paramedic managers. In contrast, other comparable countries employ paramedic self-regulatory systems combined with clinical governance to achieve the same ends.
In North America, the “medical direction” model is the dominant approach employed to ensure optimal patient outcomes in paramedic service delivery. Few participants had considered paramedicine becoming a self-regulating health profession. Those trained outside North America tended to identify self-regulation and clinical governance as the preferred approach to quality management. Participants identified three themes: first, resourcing, regulatory frameworks and fragmentation second, independent practice facilitators and barriers and third, paramedic roles and professionalisation. Researchers interviewed participants at two remote North American sites, then completed transcription and thematic analysis.
#Oversight systems professional#
The purpose of this paper is to describe and analyse two approaches to paramedic service clinical governance and quality management from the perspective of two groups of paramedics and paramedic managers working in North America.Ī case study approach was utilised to describe and analyse paramedic service medical direction in North America and contrast this with the professional self-governance and clinical governance systems operating in other high-income countries. This chapter includes four sections: an introduction to the medical oversight of EMS, followed by sections on indirect medical oversight, direct medical oversight, and the provision of direct patient care in the field. An EMS medical director is ideally engaged in all aspect of an EMS service or system, including emergency medical dispatch. EMS physicians also provide direct patient care in the field.
Indirectly, a medical director may affect patient care through the development and promulgation of protocols, the education and credentialing of EMS providers, supervision and quality improvement activities, and advocating for patients, EMS providers, and the EMS system. Directly, a physician may provide orders to an EMS provider over the radio, by phone, or on scene. Medical oversight has historically been used interchangeably with the term medical direction to describe a role that is complex and multifaceted and includes elements that affect patient care both directly (direct medical oversight) and indirectly (indirect medical oversight). Medical oversight is defined as the physician supervision of a service, group, or system providing emergency medical services (EMS).