GUIDELINE FOR THE DEVELOPMENT OF PROTOCOLS FOR
MEDICAL CONTROL PHYSICIAN ORIENTATION

Purpose:  To assist hospitals in developing a comprehensive, written, orientation training program for all physicians who provide medical direction pursuant to the Emergency Medical Service affiliation agreement.

Regulation:   Hospital Licensure Regulation 105 CMR 130.1503(C)
The Affiliate Hospital Medical Director shall provide appropriate orientation to all physicians who provide medical direction pursuant to the affiliation agreement, including but not limited to information regarding local EMS providers and point-of-entry plans.

Guideline:  Physician orientation training includes but is not limited to the following:

System Overview
Department of Public Health, Office of Emergency Medical Services (OEMS)
Emergency Medical Services System Regulations - 105 CMR 170.000
Medical Control Service Regulations - 105 CMR 130.1500 - 130.1504
Role of Regions as part of Emergency Medical Services (Region I-V)
Role of EMT personnel and their limitations under licensure/certification (e.g., Paramedic,	Intermediate, Basic, First Responder), ambulance license, and staffing configuration
EMS System models, e.g., fire service based, commercial, hospital-based, volunteer,
tiered response, “third service” municipal model
EMS and hospital affiliation
Role of Affiliate Hospital Medical Director and medical control physicians
Service area, local geographic features, hospitals’ capability, e.g., designated Trauma, 
	Stroke Service
Aeromedical Resource, e.g., availability, criteria for contact
Other issues, e.g., HAZMAT, bioterrorism, decontamination, disaster resources

Medicolegal Aspects
Responsibilities/liabilities, including M.G.L. Chapter 111C 
HIPAA
EMTALA

Principles of Medical Direction
Procedures/methods for field to hospital notification, e.g., CMED, cell phones,  
	recording devices
Procedures for medical direction communication, e.g., opening statement and identification
On-line etiquette/professionalism
Confirmation of Orders 
Limitations of pre-hospital treatment
Statewide Treatment Protocols, e.g., format, content, need for compliance, approved 
Point-of-entry protocols, e.g., trauma, stroke, STEMI, pediatric critical care 
Administrative advisories
Acceptable medications (required, optional), special project waivers, deviation from
	Protocols (Rule 13)
Medical direction for interfacility transfers, e.g., interfacility medications, equipment, staff 

ED Diversion
Who/when/how long
Patients who may not be diverted, e.g., trauma, stroke, STEMI, pediatric critical care,
patients who received services under special project waivers

Radio Communication System
CMED
Call Priority (Priority 1-4)
Proper use of equipment
Troubleshooting system
Audio recordings and tapes, e.g., access, storage issues

QA/QI
Methods/process
EMT performance reviews – methods/process
Medical control physician performance reviews – methods/process 
Remediation
QA conferences, meetings, educational programs, Morbidity and Mortality Rounds

Field Observation
Consider ED staff field observation of EMS Services