Medical control and direction of pre-hospital care

Physician input is needed throughout the planning, implementation, evaluation and audit of the Emergency Medical System. Medical control and direction of pre-hospital care is essential and at the local level, a knowledgeable and committed health-care professional should be identified to serve as the medical director. In urban areas, an experienced hospital-based physician trained in accident and emergency medicine, anaesthesiology or critical care, or trauma surgery, and ideally trained or experienced in pre-hospital care, may be best suited to this role. In rural communities where a physician may not be available, the most experienced nurse or paramedical professional should fill this role. It is important that qualified individuals be assigned responsibility for assuring the availability and quality of pre-hospital care in their community, whether it is delivered through paid health-care providers or local volunteers [50].