Page 313 - 2023 SMOG Digital

FORMS

perform simulated critical care and POI training cases on a monthly basis in order to develop
competency and retain critical care medical proficiency.
The Flight Paramedic Standard Medical Operating Guideline is not intended to be a
comprehensive patient care manual. Rather, it specifies standard clinical treatment guidelines
for discrete emergency conditions which should be used as a baseline practice standard for
Flight Paramedics and other attached medical aircrew members providing enroute emergency
care on a rotary wing platform in the prehospital environment while conducting intratheater,
CONUS, or other tactical/operational contingency missions.
QUALITY MANAGEMENT PROGRAM Procedures
Physician Medical Direction

Prehospital emergency care constitutes the practice of medicine, either directly by a qualified
physician or indirectly through delegation-of-authority under the physician’s medical direction.
This practice is distinctly different from hospital-based medical, nursing, and paramedical
practice in which practitioners conduct full-spectrum care within their respective scope-of
practice, executing physician’s orders, or through autonomous practice in the case of Physician
Assistants (PA), Nurse Practitioners (NP), and Clinical Nurse Specialists (CNS).
Medical direction of Flight Paramedics and other medical aircrew with regard to procedures,
guidelines, medications, documentation (Patient Care Reports), testing, credentials, etc., is the
primary responsibility of the qualified (as defined by AR 40-3) assigned Flight Surgeon (FS)
(normally a Battalion Surgeon), with the assistance of the Aeromedical Physician Assistant (APA)
and designated company Medical Training NCO. The Brigade Surgeon has responsibility for
overall medical oversight. All medical aircrew should maintain currency on recent literature and
equipment pertaining to pre-hospital aeromedical evacuation and enroute care.
Advanced-Care Provider Clinical Oversight

Although they cannot act as a medical director, the role of PAs, NPs and CNSs in the practice of
prehospital emergency care is emerging and holds great promise as a means of extending the
medical director’s capacity to ensure the best quality of care for patients or casualties. While
Federal Regulations and most State Laws pertaining to EMS require physician medical direction
for the prehospital conduct of advanced life support (ALS) scope-of-practice skills, many high
performance domestic EMS systems have implemented mid-level “clinical director” programs,
employing PAs and advanced practice nurses with emergency or critical care expertise, to
provide initial quality management program (QMP) review, assist with on-line decision support
for pre-hospital practitioners, oversee readiness training and continuing education, and to
augment the medical aircrew when needed on ground and air critical care transport platforms.
PAs, with the approval of the Brigade Surgeon, can provide the necessary clinical oversight in
the absence of a unit level Flight Surgeon in order to ensure the CCFPs are trained and proficient
for their deployed mission.

Quality Assurance

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