The Handbook for EMS Medical Directors was developed by the IAFC as part of a cooperative agreement with DHS, FEMA and USFA, and was supported by DHS, Office of Health Affairs. A project team representing EMS stakeholder groups worked together to develop, contribute and author the handbook. In addition to the project team, many industry professionals contributed time, information and efforts to aid in the production of the handbook. Industry stakeholder groups reviewed and provided feedback during the handbook’s production. Please see the Acknowledgements section of the handbook for a complete list of contributing individuals and groups. Their efforts are greatly appreciated.

The position of an emergency medical services (EMS) agency medical director allows the opportunity for a physician to become engaged in the unique and ever-evolving realm of out-of-hospital care, a clinical practice offering a distinct set of challenges, and rewarding impacts in improving a community’s emergency medical care abilities. For most, the driving force behind the desire to become an EMS agency medical director stems from a deep passion for helping patients in times of marked acute medical need whenever and wherever the need appears. Yet, understanding the nuances involved in the oversight and direction of an EMS agency requires specialized knowledge, skills, and abilities beyond the typical curriculum of emergency medicine or alternative acute care medical practices. It is for this precise reason that EMS has been recently recognized by the American Board of Medical Specialties as a formal physician subspecialty.

The purpose of this handbook is to provide assistance to both new and experienced medical directors as they strive to provide the highest quality of out-of-hospital emergency medical care to their communities and foster excellence within their agencies. The handbook will provide the new medical director with a fundamental orientation to the roles that define the position of the medical director while providing the experienced medical director with a useful reference tool. The handbook will explore the nuances found in the EMS industry–a challenge to describe in generalities due to the tremendous amount of diversity among EMS agencies and systems across the Nation. The handbook does not intend to serve as an operational medical practice document, but seeks to identify and describe the critical elements associated with the position.

EMS medical direction is a multidimensional activity that includes the direction and oversight of administrative, operational, educational, and clinical actions related to patient care activities. The medical director is an integral leader in an EMS agency and will serve as the interface between the agency and the medical community. The medical director must have a collaborative and cooperative approach to working with the EMS agency, as there are many who will work in concert to ensure the agency is functioning optimally.

The EMS workforce is a diverse, creative, committed, and often very street-savvy group of providers. The medical director can be most effective by meshing the physician passions for patient beneficence, scientific discovery, ethical practices, and professional development to the enthusiasm and dedication within the EMS culture. Achieving success as a medical director depends on many things. Inherent among them is a tremendous amount of motivation, willingness to learn while simultaneously teaching, and enacting solid leadership skills, all while reinforcing the roles of patient advocate, mentor, and coach. The successful medical director is equally analytical and resourceful. The medical director must focus on how to improve their agency and the service that it delivers on a continual basis. Involvement with this aspect of emergency care can be extremely rewarding, challenging, as well as personally and professional fulfilling. Physicians electing to pursue the role of a medical director are to be commended for their dedication and critical position they will hold in the public safety and health care arenas. The handbook’s chapters identify and discuss the components of an EMS agency and its agency stakeholders, the position of a medical director, and the medical director’s role in agency oversight.

The handbook contains appendices that include

  • medical director’s checklist;
  • glossary;
  • acronym guide;
  • sample agreement of service documents;
  • sample liability insurance documents;
  • industry regulations and standards; and
  • sample performance measures.

These reference items will aid in a physician’s understanding of the general role, needs, and requirements for the medical director position.

The entire 92-page handbook can be downloaded from

Michael Hosto