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EMSWORLD.com | AUGUST 2017 17 tor objects because paramedics don't diagnose, and to treat a patient without a diagnosis or a primary care physician sub- jects the company, and medical director, to unnecessary liability. What is the best decision? Case #3: BLS units and fly cars The CEO wants to introduce BLS ambu- lances and fly cars (single-resource vehicles) to an all-ALS system. He thinks this will help relieve pressure on the ALS system and cut costs. The medical direc- tor argues that determining which calls will result in ALS services puts an enor- mous burden on dispatch and increases liability. Additionally it will result in greatly increased costs because BLS units will be in addition to, not instead of, ALS units and because fly cars are a nonreimbursable expense. Which course of action should be followed? Case #4: Ultrasound The EMS CEO has been convinced by the hospital CEO that adding portable ultra- sound to each ambulance will greatly enhance patient care. Units are small, light and fairly inexpensive, and the hos- pital CEO says he will foot the bill. The medical director objects to the technol- ogy for a more pragmatic reason: Use of portable ultrasound will delay scene time, is operator-dependent, is a very perishable skill and, most important, will not materi- ally change the behavior of the EMS ser- vice. Is modern technology always to be embraced, even if it's free and useful, if it won't change behavior? While medical oversight and operations are both working toward common goals, they may often hold different priorities on how best to get there. But with open com- munication and understanding all perspec- tives, a well-run EMS system can establish itself as a leader in superior patient care. A B O U T T H E A U T H O R S Bradford H. Lee, MD, JD, MBA, is medical director for the Regional Emergency Medical Services Authority (REMSA) in Reno, Nev. Lee retired from the U.S. Air Force after a nearly 30-year career during which he held several positions, including department chair at a medical center, chief of medical staff, CEO of both bedded and nonbedded facilities, and corporate medical director overseeing practice at 65 different facilities in the United States and overseas. Prior to joining REMSA in 2013, he served as Nevada State Health Officer; in that position he was the primary public health medical advisor to two governors. Dean Dow, MBA, CMTE, joined REMSA in 2015 and is the organization's president and CEO. Prior to joining REMSA, Dow was the owner of Drawing Board LLC, where he assisted in the planning of strategic growth for ground and air medical services. He also helped develop and integrate external service lines with medical centers, including the nation's largest hospital systems. His professional career includes roles as regional vice president of Air Methods' Southeast Region; program director for LifeNet of New York; director of business development and quality assurance for EagleMed/ Ballard Aviation Inc.; fire chief for Ford County Fire & EMS in Kansas; and program director for Alaska Regional Hospital's two medical aircraft. For More Information Circle 18 on Reader Service Card