A new in-house position of medical director of emergency medical services was established last week by the Mehlville Fire Protection District Board of Directors.

The Board of Directors voted unanimously May 15 to name Dr. Christopher Bosche to the newly created in-house position. Bosche previously had served as Mehlville’s medical director when he was medical director of emergency medical services at St. Anthony’s Medical Center.

Bosche, who now works full time at St. John’s Mercy Medical Center, would serve as Mehlville’s medical director on an independent-contractor basis. When he was employed at St. Anthony’s, Bosche served as medical director for as many as nine different departments.

Board Treasurer Bonnie Stegman noted that the in-house position was proposed by Craig Walk, the district’s deputy chief of emergency medical services.

“… If you look at the literature, the way to go now is to actually have your own medical director for your department because that way you have someone that’s dedicated just to your department versus your medical director who may be associated with a hospital may have more than one service, maybe even nine or so services … With having someone that’s dedicated to our department, we will ensure the quality care and some training issues,” she said.

Board Chairman Aaron Hilmer asked Walk if other districts have an in-house medical director.

“The only organizations that I’ve been in contact with that have something similar to what we are looking to do is the city of St. Louis has Dr. (Mark) Levine as their medical director,” Walk said. “I talked to their medical officer, Monroe Yancie, who tells me that Dr. Levine is only contacted when there’s an issue or a protocol to be reviewed. So he couldn’t really give me a time factor as how much time’s dedicated to the St. Louis Fire Department. I spoke to a Taz Meyer, who’s with the St. Charles County Ambulance District. They have a physician that’s on contract with them as an independent contractor, but he also serves as the medical director for all the hospitals up there as well as Warren County Ambulance and their dispatch center.

“So what I’m proposing here is a little unique compared to what anybody else has in the area and I think the movement that this fire department is taking as far as with the ALS (advanced life-support) pumpers and employing more paramedics to ensure that we keep up with the individuals’ skill level and cognitive ability or training, you’re almost going to have to have somebody that’s more committed to doing that …,” he added.

As for having an in-house medical director, Walk continued, “I think it’s going to be an important thing for us to pursue. I think the quality of care, quality-assurance issues will be better met, quality improvement for what we can do as well as skills being evaluated on a regular basis. And I think with that in mind, we can even maybe do some more advances in pre-hospital treatments that may not be allowed if you didn’t have this type of setup …”

Bosche told the board, “… I was the former EMS director at St. Anthony’s. I was there for six years. Now I’m at St. John’s full time, occasionally you might see me part time at Anthony’s, but for the most part, I’m full time at St. John’s … I was a firefighter before I went to medical school.

“I was an EMT, worked for an air-medical helicopter service for three years, did a lot of work there … Part of the program that we’re talking about implementing here is something I’ve actually done before.

“When I was up in Ohio, we were contracted through Lucas County EMS, which is the city of Toledo and the surrounding municipalities, to provide medical direction on scene. There were four or five of us that worked as on-scene physicians …

“Basically, the idea was to do not only in-house teaching … but also to be on scene in a real environment and a real scenario and provide some direction that way. It No. 1, cuts down on the need for communication with the hospital. No. 2, it really gets you to interact well with the medics. They feel comfortable coming to you with problems and questions and things like that, and you just get a much better working relationship with the folks in the field. We’ve tried to do that when I was at St. Anthony’s to some extent, but as Bonnie was saying, I was doing nine other services at the time. I was lucky if I got out to one shift once a year just to do a site visit and try to do a brief ride along, but it really was hard to get to see everybody …”

Bosche continued, “There’s also the other aspect of medical direction, which is the chart review and that aspect — the paperwork aspect … What would make this a little different is a little bit more of a time commitment, actually in the firehouse doing some teaching …”

Hilmer asked Bosche about the workload being contemplated for the post.

“… I think what works the best was doing about three 12-hour days a month. That way, you can hit every shift,” he said. “The problem is I’m going to have to work around my ER schedule, which varies from month to month, but if I had some flexibility to hit each shift each month and then just be available for anything else you need on top of that, that wasn’t covered on those days. And that just gives us a little bit more flexibility — 36 to 40 hours a month is what we’re looking for.”

In establishing the position and naming Bosche to it, the board also agreed to negotiate a contract with Bosche for his services and consider approval of that pact at a later date.

Stegman told the Call that having an in-house medical director will be a real plus for the district and the residents it serves.

“Since most of our calls are medical, it only makes sense to make sure we have the best that we can possibly get. That way, he can evaluate our medics and make sure they have the good tools they need to do their job plus the education,” she said. “I think it’s going to be really a plus. It’s just going to make our department so much better. And it will be a plus for the medics, too … This is just kind of a win all the way around. The residents win and the employees win.”

In a separate matter, board members voted unanimously to name employees Dan Rosenthal and Dave Andrews to a district pension committee.

During a closed session May 15, the Board of Directors voted unanimously to offer employment to 12 firefighter/paramedics, according to Hilmer.

The board tentatively anticipates having four start their duties in June, four in July and four in August, he added.