At the recent IPSB Close Protection Conference in Las Vegas, Fred Burton from ONTIC stated that the most likely threat an EP specialist will encounter is medical.i Thankfully, the Global War on Terror (GWOT) is cycling down bringing many of our loved ones serving in the military back home — many of whom are highly trained, high-speed medical providers. Law enforcement and security agencies are increasingly hiring these experienced wartime medical providers to train their personnel. More often than not, however, agency leaders and owners have different expectations, ultimately resulting in highly variable competencies.
Perhaps it’s time our industry discusses the expectations and standards for providing oversight of the medical assets our companies utilize. Specifically, we need to understand what medical oversight entails, how it benefits the protection industry, and the standards to which we will hold our personnel. After all, we’re talking about the health of our organizations, personnel, clients, and obligations to protect.
Scope of the Problem
Consider for a moment the potential complex medical and surgical history any one of our principals may have (e.g., constant ailments, medications, clinician appointments, etc.). Now entertain for a moment the possibility that one or more of their family members (e.g., children) have similar, if not more complex medical needs. As you can appreciate, the scope of potential problems we may encounter on any detail, call-out, mission, etc., can dramatically increase adding further risk to an already difficult task.
What’s in a Name?
According to the U.S. Department of Health & Human Services Centers for Medicare & Medicaid Services,ii a Medical Director is a physician who “oversees the medical care and other designated care and services in a health care organization or facility.” That person is “responsible for coordinating medical care and helping to develop, implement and evaluate… policies and procedures that reflect current standards of practice.”
The Department of Health for the State of New York refers to medical control as “advice and direction provided by a physician or under the direction of a physician to certified first responders, emergency medical technicians, or advanced emergency medical technicians who are providing medical care at the scene of an emergency or en route to a health care facility”.iii
EP specialists are the de facto first responders for many medical issues involving our clients. That’s the nature of our jobs. It is, therefore, incumbent on protection agencies to employ some manner of medical oversight, preferably by a physician.
Likewise, physicians providing medical oversight to any agency employing medically trained specialists must satisfy a few very important components inherent to executive protection:
- Consistency of medical care — from ensuring adherence to standards of rendering medical care (e.g. verifying appropriate medical training and certification of personnel) to continual performance improvement;
- Credibility with clients and other professionals, medical and/or otherwise, by ensuring privacy and being cognizant of the risks that an untoward medical issue can have on a client’s security, legal exposure, brand reputation, and business valuation; and,
- Medico-legal liability mitigation and adherence to applicable laws in CONUSiv and with host nations.
As a mid-career trauma surgeon who works with special operations teams in law enforcement and the military, I am continually perplexed by the notion that anyone with advanced medical training and experience can provide medical oversight for an agency, public or private.
While there are many highly experienced and well-trained people who offer great medical training, the scope of our mission is different. We are protection specialists. Our perspective is different than that of, say, a warfighter.
So, I offer the following guidelines to my clients seeking appropriate medical oversight by a physician. Because at the end of the day, you get what you pay for.
A medical director should offer the following to their EP clients:
- Services which are of a distinct and non-competitive nature with no inherent conflicts of interest;
- Development and timely revisions of medical policies, protocols (e.g., clinical practice guidelines), and medical directives;
- Obtaining, implementing, and maintaining appropriate medical education, certification, and any necessary licensure;
- Addressing medical equipment issues (e.g., procurement, deployment, and maintenance);
- Conducting routine medical threat analyses (i.e., medical intelligence briefings) to coordinate loco-regional medical assets;
- Addressing and implementing performance and quality improvement measures;
- Ensuring appropriate communication with agency leaders and owners, clients, and their medical care providers (e.g. primary care doctors, pediatricians, orthopedic specialists, etc.);
- Giving attention to the general health and wellness of company personnel.
To this end, I recommend consideration be given to the following qualifications and characteristics of a medical director:
- Full medical licensure in the State or region where the agency is based and be in good standing with their respective boards of medicine;
- Maintain licensure in good standing with the Drug Enforcement Agency (DEA) Diversion Control Division; and/or State board that handles controlled substance registration, which includes provision for administering certain medications, for example, Epi pens and naloxone (Narcan);
- Maintain board certification in at least one (1) nationally recognized medical credentialing specialty board in a relevant medical specialty (e.g., family practice, internal medicine, emergency medicine, general/trauma surgery, etc.);
- Possess a minimum of three (3) years clinical practice experience beyond residency training in their relevant specialty and abilities commensurate with overseeing medical services rendered by EP agencies;
- For example, experience with practicing medicine in austere environments, foreign nations, or while traveling aboard aircraft, marine vessels, etc.;
- Agree to a background check, including a Criminal Offender Record Information (CORI) report from the Department of Criminal Justice Information Services (CJIS);
- Have no limitations of a physical, psychological, or personal nature (relating to political, social, and/or religious opinions) that would limit in any way their ability to perform the duties required of providing medical oversight;
- Understand and have experience with the Incident Command System (ICS) and National Incident Management System (NIMS) to facilitate integration with responding emergency service providers;
- FEMA has numerous online courses including IS-100.C and 700.B, which provide solid foundations.v
- Obtaining Medical Director certification through the CONTOMSvi course or other similar courses.
- The NHTSA website has excellent resources for medical directors. The Guide for Preparing Medical Directors is an invaluable resource for those new to the role of Medical Directorship. The guide was developed as a joint publication of the NHTSA, ACEP, NAEMSP, and HRSA.vii
Yin and Yang
It has been my experience that those teams that do well have a great relationship with their medical oversight physician. These clinicians are a trusted and integral part of the team. They are reliable because they care, routinely going above and beyond to help their people.
The surest way to show a physician sponsor appreciation for their efforts is by having a formal agreement (i.e., an MOA or MOUviii) in place — complete with commensurate compensation for their time including malpractice and professional liability costs. It completes the expectations between the sponsor and the agency, two indelible halves of the functional whole.
Most of the physicians I know who provide medical direction, like myself, have done so at an appreciable cost to our personal lives and professional careers. Why? Because we love the job, and we derive great personal satisfaction from using our skills to improve the lives of those around us. We know how much coming out of our ivory towers means to those people we’ve had the pleasure to work with and care for.
As our industry discusses standards that guide our executive protection practices, we should remember there is always a yin to every yang. We should start expecting a higher standard in our medical oversight and providers. To do otherwise, in my opinion, is negligence in providing complete protection for our clients.
About the Author
Dr. DeBusk holds dual certification from the American Board of Surgery in General Surgery and Surgical Critical Care and specializes in trauma and emergency surgery. “Doc” completed a general surgery residency at Harvard Medical School’s, Beth Israel Deaconess Medical Center, and completed a Post-Doctoral Fellowship at MIT during his residency. He is a Fellow of the American College of Surgeons (ACS) and College of Chest Physicians. He is an elected member of the American Association for the Surgery of Trauma and the ACS National Committee on Trauma. Dr. DeBusk also holds full medical licensure to practice in multiple U.S. states.
Doc combines his zeal for tactical medicine and special operations with his experience in academic medicine as an Associate Editor for the Journal of Special Operations Medicine. He provides concierge medical direction to law enforcement, EMS organizations, and executive protection groups. He is a proud member of the Board of Executive Protection Professionals where he provides guidance on requisite medical standards for protection specialists.
Dr. DeBusk can be reached at email@example.com, on social media, or through his company’s website, www.Aspitha.com.
i Burton, Fred. The Horizon View of Threats. International Protective Security Board (IPSB) Close Protection Conference. Westgate Las Vegas Resort and Casino, Las Vegas, NV. December 8-10, 2021. http://ips-board.org/2021-agenda/
ii CMS Manual System, Pub. 100-07 State Operations, Provider Certification Transmittal 15, November 28, 2005. SUBJECT: Medical Director Guidance. Website accessed on September 6, 2021, at https://www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/Downloads/R15SOMA.pdf
iii Bureau of EMS Policy Statement. Policy Statement# 95-01. Date March 30, 1995. Subject: Providing Medical Control. Website accessed on September 6, 2021, at https://www.health.ny.gov/professionals/ems/policy/med_ctrl.htm
iv CONUS Continental United States
v FEMA Federal Emergency Management Agency. Website accessed on December 15, 2021, at https://training.fema.gov/emi.aspx
vi CONTOMS Counter Narcotics and Terrorism Operational Medical Support. Website accessed December 15, 2021 at https://contoms.chepinc.org
vii NHTSA National Highway Traffic Safety Administration, ACEP American College of Emergency Physicians, NAEMSP National Association of EMS Physicians, HRSA Health Resources and Services Administration under the U.S Department of Health and Human Services. Website accessed on December 13, 2021, at https://one.nhtsa.gov/people/injury/ems/2001GuideMedical.pdf
viii Memorandum of Agreement; Memorandum of Understanding