• Emily Raetz, Elliot Ross, Brittany Dickerson, and Benjamin Walrath.
• Department of Emergency Medicine, US Naval Hospital Guam, FPO, AP 96540-0003, USA.
• Mil Med. 2023 Mar 20; 188 (3-4): e811e816e811-e816.

IntroductionMedical direction has been the cornerstone to safe and effective prehospital and enroute care since the establishment of emergency medical services (EMS). Medical oversight by a physician has been shown to improve clinical outcomes in both settings. When the Navy Regional Office of the EMS Medical Director was established in 2016, it brought additional resources, including the addition of a paramedic and nurse EMS analyst and recruitment of additional local medical directors (LMDs). This, combined with the engagement of military leadership, allowed for expansion and improvement of medical direction in our prehospital and enroute care system and the establishment of a continuous quality improvement (CQI) program.Materials And MethodsIn 2017, a database was created to collect total run volume, acuity of calls, number of certain time-sensitive conditions, and CQI performance. A retrospective review of this database was conducted. This project was deemed institutional review board exempt.ResultsLMD reports that submission went from 17% for 2017 to 64% for 2018, 91% for 2019, and 79% for 2020. In 2019, 67% of the sites had verifiable CQI programs and, in 2020, this improved to 80% of sites. The review also revealed insight into levels of acuity seen by prehospital and enroute care providers.ConclusionOur results demonstrate that improvement in medical oversight in a large regional prehospital system can be achieved through persistence and engagement of nonmedical leadership.Published by Oxford University Press on behalf of the Association of Military Surgeons of the United States 2021. This work is written by (a) US Government employee(s) and is in the public domain in the US.

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