This chapter governs the requirements for medical direction of EMS providers. All medical direction shall be in accordance with the “Maryland Medical Protocols for Emergency Medical Services Providers”. An EMS operational program shall have an EMS operational program medical director appointed by the EMS operational program. Qualifications of an EMS Operational Program Medical Director. An EMS operational program medical director shall: Be a Maryland-licensed physician or a physician employed in the service of the federal government performing duties incident to that employment; Be familiar with the design and operation of EMS operational programs and systems including medical dispatch and communications; Have experience in and current knowledge of emergency care of patients who are acutely ill or injured; and Possess current knowledge of the Maryland EMS System including: Applicable laws and regulations, The Maryland Medical Protocols for Emergency Medical Services Providers, Applicable EMD protocols, Disaster and mass casualty plans, Organization and structure, and Medical quality assurance process. Duties of an EMS Operational Program Medical Director. The EMS operational program medical director shall: Be responsible for providing medical oversight of patient care, including emergency medical dispatch, in the EMS operational program; Approve, participate in, and provide medical expertise for the EMS operational program in: A comprehensive quality assurance plan covering all aspects of EMS patient care, including emergency medical dispatch under COMAR 30.03.04, Standard operating procedures for the EMS operational program under the Maryland Medical Protocols for Emergency Medical Services Providers, Appropriate EMS provider remedial and continuing educational programs, Credentialing of EMS providers, Timely review and approval of medical equipment used by the EMS operational program to implement the Maryland Medical Protocols for Emergency Medical Services Providers, and All aspects of the EMS operational program which impact patient care, including planning, development, and operations; Provide timely approval of applications to MIEMSS for licensure and certification and renewal of licensure and certification for all EMS providers affiliated with the EMS operational program; Review patient care disciplinary matters under COMAR 30.02.05 concerning EMS providers affiliated with the EMS operational program; and Provide a liaison to the medical community as well as regional and State EMS medical directors. The EMS operational program medical director may delegate any of the duties listed in §C(1) of this regulation to an assistant medical director. The EMS operational program shall notify MIEMSS immediately of any proposal to change its medical director. Appointment of a Regional Medical Director. Each EMS region shall have a regional medical director: Recommended by the EMS regional council; and Appointed by the State EMS Medical Director. Qualifications of a Regional Medical Director. A regional medical director shall meet the requirements of Regulation .03B of this chapter. The requirements of Regulation .03B(4) of this chapter may be satisfied by completing: The Maryland Medical Director Orientation Course; or A MIEMSS-approved equivalent. Duties of the Regional Medical Director. The regional medical director shall: Serve as the principal medical advisor to the: EMS regional council, Hospital base stations within the region, Jurisdictional EMS operational program medical directors, and MIEMSS regional staff; Assist jurisdictional EMS operational programs with recruitment and orientation of medical directors; Verify the qualifications of jurisdictional EMS operational program medical directors; Make recommendations regarding the designation of hospital base stations; Assist the State EMS Medical Director in planning and coordinating base station activities; Provide medical oversight of base station quality assurance activities in the EMS region; Serve on the Regional Medical Directors Committee; and Participate in a regional interjurisdictional quality assurance program. Appointment of Associate Regional Pediatric Medical Directors. Each EMS region shall have an associate regional pediatric medical director: Nominated by the EMS regional council; Approved by the State EMS Medical Director; and Appointed by the Associate State EMS Medical Director for Pediatrics. Qualifications of an Associate Regional Pediatric Medical Director. An associate regional pediatric medical director shall: Meet the requirements of Regulation .03(B) of this chapter; and Be Board certified or Board prepared in a specialty relating to pediatrics approved by the American Board of Medical Specialties. The requirements of Regulation .03B(4) of this chapter may be satisfied by completing: The Maryland Medical Director Orientation Course; or A MIEMSS-approved equivalent. Duties of an Associate Regional Pediatric Medical Director. The associate regional pediatric medical director shall: Serve as principal pediatric medical advisor to the EMS regional council, and regional and jurisdictional medical directors; Participate in the development of the protocols on pediatric content; Serve on the State Pediatric Emergency Medical Advisory Group (PEMAG); Serve as a resource for professional education in pediatrics within the region; Chair the regional pediatric EMS advisory committee and provide a liaison between that committee and the EMS regional council, regional medical director, and PEMAG; and Provide pediatric consultation on regional and State EMS system quality assurance matters to the regional medical director, Associate State EMS Medical Director for Pediatrics and the State EMS Medical Director. The EMS operational program medical director and EMS operational program shall determine, through clinical evaluation and other means as necessary, the capabilities and skills level of each affiliated EMS provider including the ability of the provider to function independently within that EMS operational program. The EMS operational program medical director and the EMS operational program are responsible for monitoring all EMS providers through a comprehensive quality assurance program under COMAR 30.03.04. The medical director of a specialty care transport program may delegate aspects of credentialing to an associate medical director or Maryland licensed critical care transport nurse. In association with or through the granted authority of an EMS operational program, an EMS operational program medical director may suspend or limit the privileges of an EMS provider within that EMS operational program if, in the opinion of the EMS operational program medical director, the EMS provider poses an imminent threat to the health or well-being of patients. If the EMS operational program medical director suspends or limits the privileges of an EMS provider under §C of this regulation, the EMS operational program medical director and the EMS operational program shall immediately notify the State EMS Medical Director of: The circumstances and grounds for the action; Specific plans for remedial education; and The process, including reevaluation, by which the EMS provider may be able to regain privileges. The EMS operational program's policies and procedures, which shall include procedures for due process as the EMS operational program may require, shall govern suspensions and limitations of EMS provider privileges. This regulation does not otherwise affect the rights of parties under an employer-employee relationship or other contractual relationship including the rights of discipline and termination. An EMS provider shall utilize online medical direction as required in the Maryland Medical Protocols for Emergency Medical Services Providers from: An approved base station; or A system medical director. An EMS provider may receive online medical direction from a licensed physician present at the scene. Any such online medical direction, received under §B of this regulation, shall be consistent with the Maryland Medical Protocols for Emergency Medical Services Providers. Any online medical direction, received under §B of this regulation, which deviates from the Maryland Medical Protocols for Emergency Medical Services Providers shall be approved through consultation with: An appropriate base station; or A system medical director. Education Article, §§13-509, 13-510, and 13-516, Annotated Code of Maryland Effective date: December 15, 1999 (26:24 Md. R. 1859) Regulation .03B amended effective November 10, 2025 (52:22 Md. R. 1096) Regulation .04A, C amended effective July 1, 2002 (29:12 Md. R. 931) Regulation .05C amended effective July 1, 2002 (29:12 Md. R. 931) Regulation .06 amended effective January 15, 2005 (31:26 Md. R. 1866)