# EMS Medical Director Engagement Checklist
*EMS AI Stack, by Dr. A. Keith Wesley, MD, FACEP, FAEMS. Free to use and share. Not legal advice; requirements vary by state.*

Use this checklist to assess how engaged your agency's physician medical oversight really is. Mark each item **Yes / Partly / No**. Several "No" answers suggest a "phantom" medical director: someone whose name is on the paperwork but who isn't involved in the system.

## 1. Accountability and authority
- [ ] We have a written agreement with our medical director that defines duties, time commitment, and authority.
- [ ] The medical director meets our state's qualification and credentialing requirements (and current state rules have been checked).
- [ ] Crews know who the medical director is and how to reach them.
- [ ] There is a named backup or associate medical director for when the primary is unavailable.

## 2. Protocols
- [ ] Protocols have been reviewed and signed by the medical director within the last 12 months (or as often as your state requires).
- [ ] Protocol changes are based on current evidence and communicated to crews with education.
- [ ] Protocols match the equipment and medications actually carried on our units.
- [ ] There is a process for crews to suggest protocol changes and get a response.

## 3. Quality assurance and improvement
- [ ] There is a written QA/QI plan the medical director has approved.
- [ ] High-risk calls (cardiac arrest, airway management, STEMI, stroke, pediatrics, refusals, restraint) are routinely reviewed.
- [ ] The medical director personally reviews at least some charts and gives feedback.
- [ ] QA findings lead to education or protocol changes, and we track whether they worked.
- [ ] QA is educational and non-punitive whenever possible.

## 4. Education and credentialing
- [ ] The medical director (or their designee) takes part in continuing education.
- [ ] There is a process to credential new providers before they practice independently.
- [ ] High-risk, low-frequency skills (surgical airway, pediatric resuscitation, etc.) are reviewed and practiced.
- [ ] Remediation plans exist and are used.

## 5. Presence and relationships
- [ ] The medical director rides along, visits stations, or attends crew meetings at least occasionally.
- [ ] The medical director has a working relationship with receiving hospitals and dispatch.
- [ ] Crews feel comfortable calling the medical director about a difficult call.
- [ ] Online (real-time) medical control is available and works.

## 6. Risk and documentation
- [ ] Sentinel events and near-misses are reported to, and reviewed with, the medical director.
- [ ] Controlled-substance policies are approved and audited.
- [ ] Use of new technology (including AI tools) is approved by the medical director and the agency, with PHI protections in place.

## Scoring
- **Mostly Yes:** you have engaged medical oversight. Keep it up and document it.
- **Several Partly/No:** schedule a meeting with your medical director and agency leadership to close the gaps.
- **Mostly No:** your system may be exposed to protocol drift, unreviewed care, and liability. Talk to your agency leadership and your state EMS office about your options.

## References
- National Association of EMS Physicians. *Physician Oversight of Emergency Medical Services* (position statement). Prehospital Emergency Care. 2017;21(2):281–282. doi:10.1080/10903127.2016.1229827. https://naemsp.org/position-statement/physician-oversight-of-emergency-medical-services/
- Check your state EMS office's rules for medical director qualifications and duties.

Want help? Visit https://emsaistack.com/phantom-medical-director/