As in most communities, Upper Arlington residents expect paramedics and ambulances to come when they call, to offer treatment that could include administering drugs or using automated CPR devices and to transport them to a hospital if needed.

What they might not know is that none of the city's emergency-medical services would be possible without a state-required medical director or adviser. That person's medical license provides the authority for the Upper Arlington Fire Division to obtain and use such narcotics as valium, morphine and fentanyl in the field while responding to and treating medical emergencies.

Were you aware of the Upper Arlington Medical Advisory Board? Read about the organization in this week's#UpperArlington News:

— ThisWeekNEWS (@ThisWeekNews)April 3, 2019

They also might not know that the physician-oversight system in place for Upper Arlington's EMS is different than in other central Ohio communities: Its medical director, Dr. Michael Dick, an emergency-medical and critical-care specialist at the Ohio State University Wexner Medical Center, is backed by six other members of a medical advisory board.

And all of them are unpaid volunteers who are appointed by the Upper Arlington City Council president and approved by the full council to serve four-year terms.

Fire Chief Lyn Nofziger and Dick both call Upper Arlington's setup "unique."

"Most, if not all, EMS agencies have a paid medical director," Dick said. "Upper Arlington uses strictly volunteers. Utilizing the board structure allows us to have several content experts providing input to the EMS system."

Diverse specialties

Dick said a conscious effort is made to have multiple specialties represented on the medical advisory board -- emergency medicine, cardiology, trauma surgery, pediatrics -- and also to have different health systems represented.

"The board should only recommend transport destinations based on matching the needs of the patient with the resources a facility can provide," he said. "Having diverse representation prevents any illusion of influencing where patients are transported."

>> UA Medical Advisory Board bios << >> Criteria for medical advisory board and director <<

Nofziger said he believes the extra expertise that comes from having a seven-member board instead of a medical director only enhances Upper Arlington's EMS system.

"When they get together as a group and they work on different protocols or run critiques, we're able to get different perspectives," he said. "Medicine is specialized these days. By having a medical advisory board, you're able to get the best of everything."

Currently, there is one vacancy on the medical advisory board that the city is seeking to fill, although there is no timetable for doing so.

In addition to Dick, the board members are:

* Dr. Eric D. Drobny, an emergency-medicine specialist with Emergency Services Inc., an affiliate of Mount Carmel Health System.

* Dr. Mary E. Fontana, who specializes in internal medicine and cardiovascular disease for OSU Internal Medicine LLC.

* Dr. Medard R. Lutmerding, an emergency-medicine specialist, also with Emergency Services Inc.

* Dr. Bradley Raetzke, a specialist in emergency medicine for OhioHealth.

* Dr. Rachel Stanley, a pediatric-emergency specialist with Nationwide Children's Hospital.

Duties of director, board members

So what are Dick's responsibilities as medical director and what does the medical advisory board do?

As medical director, Dick has authority over all clinical and patient-care aspects of the Upper Arlington Fire Division's EMS system.

"I am the person listed on regulatory documents, such as our protocol, which provides guidance for the clinical care; the drug license; and serve as the listed medical director for the paramedics to maintain their certification," he said.

The medical advisory board, according to the legislation that established it on Feb. 1, 1977, is charged with providing "ongoing professional supervision, training and support of the city's emergency para-medicine program."

One of the things the board does is set guidelines -- protocols -- for how EMS personnel should respond in specific situations.

"For example: a heart attack victim," Nofziger said. "The protocol lays out exactly what we need to do: We need to take their vital signs. We need to assess their EKG, put them on a heart monitor, find out what the issue is, if there are any cardiac drugs we need to give them. It kind of lays out what we need to do for each particular situation."

The board also offers "quality review when the EMS division has questions," Dick said. "We review, and usually approve, new additions to the protocol, new equipment, etc."

In Upper Arlington, those additions have included the use of mechanized CPR devices and an ultrasound-guided IV program, according to Nofziger.

The medical advisory board meets twice each year, once in May and once in December, to assess the past year's EMS runs and update training for everything from responses and dosage guidelines for various medications to how to treat someone overdosing on heroin or other opioids.

Capt. Chris Moore, the fire division's EMS officer, serves as the liaison between it and the medical advisory board.

Moore said he communicates with the board -- primarily Dick -- throughout the year to discuss emergency-medical trends and issues, as well as practices or technologies that could be applied to EMS operations.

He also meets with board members during their two meetings each year to review documents, processes and protocols.

"We go over the data from the previous six months -- the types of runs we've responded on, the things we're seeing. They provide feedback that can then be translated into training for paramedics," Moore said. "From time to time, we will have one of the board members come in and do division training to enhance what we do."

Residency requirement

By statute, Upper Arlington's medical advisory board members must live in the community and, although they must apply to fill any openings, they often are referred to city leaders by current or past board members.

Moore said the fire division looks for specialized physicians and recommends candidates to the council president.

Because of the responsibility the medical director carries, with the fire division operating under his or her medical license, Nofziger said he would be open to having city officials explore the possibility of providing some compensation to that individual.

"They have kept us, really, at the forefront of EMS," Nofziger said of the medical advisory board. "I can't overstate the importance of this group in providing high-quality emergency-medical services to Upper Arlington."



Medical director arrangements vary elsewhere in central Ohio

A check of other cities in central Ohio shows they have medical directors in place for their emergency medical services, as required by state law. Unlike Upper Arlington, which has an unpaid medical director and a seven-member advisory board, the medical directors in other communities are paid. Arrangements and pay scales vary widely, however.

* Columbus has a medical director, Dr. David Keseg, who is paid $180,793.60 per year ($86.92 per hour), according Rebecca Diehm, assistant public-information officer for the Columbus Division of Fire.

* Dublin gets its fire and EMS coverage from the Washington Township Fire Department and has two medical directors, one for adults and one for pediatrics, according to township communications manager Leslie Dybiec. Under an agreement that went into effect in March 2018, Washington Township became part of a consortium with Genoa, Harlem, Liberty and Orange townships and the city of Delaware to adopt common EMS protocols and share medical director services.

Dybiec said Dr. Ann Dietrich handles pediatric cases and is paid $8,284 yearly by Washington Township.

Dr. Paul Gabriel handles adult cases and is paid $16,567 per year by Washington Township.

* Hilliard gets its fire and EMS services from the Norwich Township Fire Department, which pays Dr. Rob Lowe $1,500 quarterly ($6,000 a year) to act as medical director, according to fire Chief Jeff Warren.

* Westerville's medical director is Dr. Frank Orth. Community-affairs director Christa Dickey said the city does not pay him a salary since he isn't a city employee, but it does pay an annual fee to his consulting business, Kalispell Bay Consulting.

Dickey said no amount has been paid yet this year, but the last payment was made in December 2018 for $10,000.

* Worthington's medical director is Dr. Doug Rund. Public-information officer Anne Brown said the city contracts with the Ohio State University Wexner Medical Center Department of Emergency Medicine for services and pays Rund $1,000 a month.