This is part of a series of articles from MONOC Mobile Health Services, New Jersey's largest provider of EMS and medical transportation and first CAAS-accredited agency. The goal of this series is to provide insight and solutions for the different managerial and operational challenges facing the EMS leaders of tomorrow. For more, see www.monoc.org.
You want to make a protocol change for your EMS department. You draft the change and present it to your medical director for his review and approval. You discuss your feelings with him and what it would take to implement the new protocol, and deal with any specific bias that he may have either from his education, practice or the practice of the facility where he works. You make adjustments to the protocol that he requests and then present it to your staff for implementation.
But what if your medical direction is from a board of physicians from different hospital systems, all with equal say in drafting that protocol? You may have multiple biases to deal with, as well as vast differences in practice from facility to facility. This is a key issue when dealing with a medical advisory board versus an individual medical director. The dynamic can be very frustrating, but it can also be very fulfilling.
The model we use at our service consists of a medical advisory board with 12 physicians who represent 11 different hospitals. The system's medical director is elected from among these physicians to chair meetings and for regulatory purposes. Some of the physicians on the board work at university hospitals, while some work at community hospitals. Within a group this size, there will be some physicians who are very progressive in their approach to prehospital patient care and are a true ally to a clinical department that wants to keep its service on the cutting edge, while others may tend to be more conservative, acting as a counterbalance and ensuring that the agency takes its time and fully considers each new protocol prior to its implementation. Both mindsets can be an asset to an EMS service.
Some of the physicians on a medical advisory board may be prolific researchers with several published projects; while others may work in hospital systems that have not "grown with the times" and therefore had little opportunity to participate in research of any type. Physicians from less progressive hospitals may be conservative in their thinking and practice, and therefore may take a great deal of convincing when it comes to seeing the value of a new procedure or protocol. This can of course be frustrating for a clinical department that is working to develop what it considers to be best practices within an agency. One thing is certain—the progressive vs. conservative dynamic will lead to some very interesting discussions. At the end of the day, these discussions will serve to make sure a decision has been fully weighed before its implementation.
In many cases, the extra effort it takes to win over the conservative physicians on a medical advisory board may actually lead to your EMS system driving procedures or protocols in those physicians' emergency departments. Your EMS system may begin utilizing a procedure in the field that a smaller emergency department is not familiar with. The smaller department may at first question the procedure, but the influence of your hard-won medical advisory board member will help them realize that this will benefit patient care and thus hasten the process of bringing the procedure to their ED.
This was the case for our service when we began to use EZ-IO for vascular access on critical patients. Our clinical department visited several emergency departments within our system to in-service their staff on this device. As those staff members began to see how easily and effectively the drill was being used in the field, they began to ask why it was not being used within their own hospitals. Because of their familiarity with the device, members of our medical advisory board who represent those hospitals were able to take the lead in bringing this new tool to their facilities.