• C B Custalow, M Armacost, and B Honigman.
• Department of Emergency Medicine, University of Virginia Health Sciences Center, Charlottesville 22906-0014, USA. cbc3d@virginia.edu
• Acad Emerg Med. 2000 Jun 1;7(6):674-8.

BackgroundMany rural communities have difficulty maintaining a medical director for their emergency medical services (EMS). Local physicians may be overwhelmed, be hesitant to take on additional responsibilities, and feel unskilled in providing the necessary leadership. Without a medical director, rural EMS agencies are frequently forced to shut down, thus depriving the community of local out-of-hospital care.ObjectivesTo meet the needs of rural EMS agencies for medical direction, to provide a unique opportunity for emergency medicine (EM) residents to acquire EMS medical direction skills, and to fulfill the obligation of EM residencies to provide both didactic and experiential training in EMS.Program DescriptionThis article describes a curriculum, now being used in Colorado, for placing EM residents as EMS medical directors for rural out-of-hospital agencies that have lost their medical directors. Residents visit these rural communities 6-12 times a year, provide continuing education through interactive lectures, develop or revise EMS protocols and policies, perform quality assurance reviews, troubleshoot problems, and assist in EMS planning for the community. Residents are supervised by the Colorado state EMS medical director.ConclusionsThis unique program enables local EMS agencies to continue their service while providing clear educational benefit for the EM residents. This paper demonstrates how this program has been working successfully in the state of Colorado by placing residents in four distinct rural and mountainous communities.

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