EMS Systems - Medical Direction

Medical direction refers to medical, policies, procedures, and practices available to providers either online or offline. A medical director is a physician who is legally responsible for all clinical and patient care aspects of the system. All that means is anything you do as a paramedic is technically through your medical directors licence since you don't have a medical licence...yet. The medical director carries a plethora of roles in the system including:

-Educate and train personnel
-Participate in personnel and equipment selection
-Develop clinical protocols with the help of expert EMS personnel
-Participate in quality improvement and problem resolution
-Provide direct input into patient care
-Interface between EMS and other healthcare agencies
-Advocate within the medical community
-Serve as the "medical conscience" of the EMS system, including advocating for quality patient care

There is Online Medical Direction which involves actually getting orders for patient care in the pre-hospital setting from a licensed and qualified physician via radio or phone. It allows immediate consultation with a licensed physician to provide instant diagnostic information.

Then there is Offline Medical Direction which refers to the medical policies, procedures and practices that are put in place by medical direction before a call ever happens. This also includes aspects of the systems such as auditing, peer review and quality assurance measures.
Protocols are the policies and procedures of for all components of an EMS system. They provide the standard for patient care, treatment and also provide the baseline for accountability. Protocols for the EMS system are based around the 4 Ts of emergency care:

Triage- Guidelines to address how patients flow through an EMS system. Includes the ways in which system resources should be used to meet patient needs.

Treatment- Guidelines to identify procedures to be performed on direct order from medical direction and procedures that are standing order (preauthorized treatment procedures, a type of treatment protocol)

Transport- Guidelines that address the mode of travel based on patient's injury/illness, the condition of the patient, level of care required and estimated transport time (air vs ground transport).

Transfer- Guidelines to ensure patient is taken to the most appropriate receiving facility for definitive care.

Protocols are also in place for special circumstances such as DNRs, sexual abuse, child or elder abuse, refusal of care, termination of CPR and what to do in the case of intervener physicians. Protocols should standardize field procedures, but still allow the paramedic flexibility to improvise and adapt to unforeseen circumstances.

Information from the Essentials of Paramedic Care Volume 1.