Medical control and accountability of emergency medical services (EMS) systems

The passage of the Emergency Medical Services Systems (EMSS) Act of 1973 and its amendments in 1976 has provided the mechanism and funds for communities to develop regional basic life support (BLS) and advanced life support (ALS) EMS delivery systems across the nation. With the passage of the EMSS Act, Congress mandated that emergency medical care programs funded with federal dollars must utilize a "systems approach" for the provision of emergency response and medical care. In the EMSS Act some 15 component requirements have been identified to assist system planners, coordinators, and operators in their attempts to establish comprehensive, areawide, and regional EMS programs. The EMS system utilizes physician extenders, paramedics, and other systems personnel. Medical supervision of these paraprofessionals under the direction of "administrative (off-line) medical directors" and "supervising ALS (on-line) medical directors" is essential to the operation of BLS and ALS systems. This paper outlines the mechanisms for medical control and accountability of the interaction between professional and paraprofessional emergency medical providers, i.e., utilization of protocols (treatment, triage, operations), designation of resource and associate medical control hospitals, model configurations (X centralized and Y satellite), and communications technology for systems operations and program monitoring.