State Requirements for Medical Directors in the United States

Background: The requirements for emergency medical services (EMS) medical directors are commonly defined by state rules and regulations without national standardization. The extent of variability in the requirements to be an EMS medical director in the US is unclear. The objective of this study is to describe the state requirements to function as an EMS medical director in the US. Methods: This was an evaluation of the rules and statutes governing the current requirements to function as an agency-level EMS medical director and defined tasks in the US. Regulations and governmental statutes were reviewed from 50 states and the District of Columbia using publicly available governmental websites focusing on the specific qualifications required to work as an EMS medical director and perform the associated tasks. Data were tabulated, and descriptive statistics were calculated. Results: Data were available and extracted for all 50 states and the District of Columbia. Being a licensed physician is the minimum requirement in 50 states (50/51, 98%). One state, Montana, allows for medical direction by a licensed physician or physician assistant. Board certification in emergency medicine is required by 8% (4/51). No state requires EMS subspecialty certification. The majority of states require that EMS medical directors participate in EMS oversight (76%), EMS clinician training (71%), protocol development (67%), and quality improvement and assurance (65%). Conclusions: Requirements for EMS medical direction across the US are not standardized. Many states require a medical license, but emergency medicine board certification is not a common requirement. Future work will need to focus on required competencies for EMS medical direction to set clear standards and educational requirements in the US.