Our Story
A New Approach
International Medical Direction LLC was born out of a visionary approach to revolutionize EMS medical oversight. In the early 2010s, as healthcare landscapes shifted, our founders recognized the need for a centralized system that could provide consistent, high-quality medical direction across diverse EMS agencies. This novel apprach required the centrifuge of all support structures for a complete package better than existing ‘base stations’.
This would requre administrative medical direction, online medical direction, education, qaulity assuarnce, and technology to glue it all together.
The Formation
**International Medical Direction LLC (IMD)** was founded by four original partners during their involvement in hospital and fire-based EMS agencies participating in the CMS Innovation Grants of 2011-2012. At that time, they anticipated the need for more advanced models of EMS care, such as the recently developed CMS ET3 model. The team recognized that the traditional hospital-based EMS model, where EMS agencies rely on single-hospital or single-ACO systems for oversight, was outdated and insufficient for the evolving landscape of community-based care.
Emerging EMS models like Community Paramedicine and ET3 were designed primarily for single-hospital or ACO systems and often failed to accommodate municipal or community EMS providers. These providers, which serve multiple hospitals and are focused on patient-centered care, were left out of these narrowly focused programs. In multi-ACO regions, where two or more hospital systems coexist, implementing coordinated programs for primary prevention, secondary prevention, and readmission avoidance — the core of ideal community paramedicine models — proved challenging. Without data-sharing platforms and complex consortium agreements, these programs struggled to achieve broad, system-wide participation.
Despite these challenges, EMS providers, including EMRs, EMTs, AEMTs, and paramedics, are still required to work under the supervision of an emergency room (ER) physician to ensure safe and effective patient care. Traditionally, many EMS agencies have relied on ER-based physicians for this oversight. However, as hospitals face financial pressures from declining reimbursements, rising patient volumes, and tightening budgets, they have been reducing their support for EMS teams.
In response, many ER/EMS physicians have sought independent practice, focusing on EMS care. However, solo practitioners often find it difficult to meet the administrative demands of modern EMS agencies, which can affect the quality of oversight and, ultimately, patient care.
IMD addressed this gap by establishing a centralized EMS medical direction group, operating under Arizona state laws to provide comprehensive, cohesive administrative oversight, online medical direction, and support services for EMS agencies and mobile medical teams worldwide. By consolidating support services, IMD offers economies of scale, ensures impartial oversight, and provides efficient, high-quality support to EMS teams.
Since its inception, IMD has focused on integrating innovative services such as community paramedicine and, in the future, telemedicine, into its platform. We have set a high standard for EMS medical direction, assembling a team of licensed, experienced, and respected ER/EMS physicians to lead the way. Our investment in infrastructure includes a state-of-the-art cloud-based learning management system (CLC), advanced communication tools, quality assurance systems, and real-time alerting systems — all supported by a full-time, in-house staff to ensure seamless medical supervision and operational efficiency.
IMD’s services cover all aspects of online and administrative medical direction, including managed continuing education, pharmaceutical support, quality assurance, and records management, all led by our experienced Medical Directors.