EMS System Profile
Washtenaw/Livingston Medical Control Authority
Ann Arbor, Michigan
Robert Domeier, MD, FACEP
Deputy Medical Director
Constance Doyle, MD
Washtenaw/Livingston Medical Control Authority
P.O. Box 130448
Ann Arbor, Michigan 48113
EMS System Direction
Medical oversight in the Washtenaw/Livingston County Medical Control Authority (MCA) is provided by the Washtenaw/Livingston County Medical Control Corporation. This non-profit organization is designated by the EMS Section of the Michigan Department of Consumer and Industry Services as the medical control authority for Washtenaw and Livingston Counties, as well as Lyon Township of Oakland County (population 350,000).
The Washtenaw/Livingston EMS system includes urban, rural and suburban geographic areas. Ambulance transport is provided by two ALS services. A nonprofit community ambulance serves Washtenaw County. Livingston County is served by a county operated service that is separate from fire service and funded by a county millage. AED-equipped medical non-transporting first responder service is provided by 25 area fire agencies (volunteer and full time). One of the non-transporting services has upgraded to the basic non-transporting level and more fire departments are considering this option. Two hospital-based air ambulance programs also provide prehospital response.
Funding is supported primarily by the area hospitals, with prehospital transporting service providing funding support through a voluntarily agreed-upon assessment (based on the number of vehicles operated). Staff support is provided by Washtenaw County through the medical control corporation, which pays all costs of the staff support including a percentage for county overhead expenses.
The medical control corporation is composed of hospital administrators from the five member hospitals with voting representation based on emergency department ambulance volume. The medical control corporation meets annually to approve the budget for the medical control authority. Our member hospitals are Chelsea Community Hospital, St. Joseph Mercy Health System, St. Joseph Mercy Livingston Hospital, St. Joseph Mercy Saline Hospital and The University of Michigan Health System.
The medical control authority board is composed of two representatives from each of the hospitals, one from each transporting ambulance service, one from each air ambulance service, and one member representing the medical first responders from each county. All members of the board have one vote. The board elects the medical director from the hospital physician representatives. The medical control authority board is responsible for supporting education with the system. The Washtenaw/Livingston County MCA grants privileges for paramedic practice within the EMS system based on a written test and mandatory operating room intubation training, as well as procedure orientations.
The Washtenaw/Livingston MCA staff consists of:
Medical Director (one-quarter time position)
Deputy Medical Director (one-tenth time position)
Medical Control Staff (full-time position)
There are several committees and task forces which support the activities of the medical control authority board:
Advisory Body Committee
Data and Evaluation Subcommittee
Professional Standards Review Organization
These committees have varying representation from the hospital and prehospital agencies.
The system has initiated an adult and pediatric trauma triage program which directs significant trauma patients to the two hospitals in the system that serve as the trauma centers for the system. The medical control authority oversees the function of a paramedic-staffed mobile intensive care unit for interfacility patient transfer, which is capable of managing patients on ventilators and multiple medication drips. Pre-hospital 12-lead ECG is available within the system and prehospital paralytic intubation is allowed by the State of Michigan as a special study.
Special rescue and hazardous materials responses are coordinated through area fire departments that also serve as medical first responder agencies. A paramedic hazardous materials medical response team has been developed and the system uses specialized hazardous materials treatment protocols and is equipped with a hazardous materials drug box. The Washtenaw/Livingston County MCA provides medical oversight for each of these activities. The medical control authority board has two representatives on the Washtenaw County EMS Commission, which oversees the countys contract for EMS care to the community. The EMS disaster plan is incorporated into the disaster plans for both Washtenaw and Livingston Counties.
On-line medical direction is provided by emergency physicians and nurses at three of the five system hospitals. These three hospitals provide on-line medical direction for patients transported to its institution and for patients transported to the two acute care hospitals that do not provide on-line direction. Each hospital provides an orientation to new physicians as clearance to provide on-line medical direction.
On-line communications are called directly to the hospitals providing medical direction. Disaster communications are coordinated through a central communications center. The communications center is based at one of the ground ambulance dispatch centers which provides daily communications checks. The hospital providing on-line medical direction is the medical control hospital closest to the prehospital scene. Radio communications occur on UHF frequencies. Telemetry transmission is not used. VHF communication is used for notification when no on-line direction is anticipated by the prehospital personnel and for trauma notification. Cellular resources are also available in the system.
Revised March 28, 2007