| Cushman et al. (2010) | Retrospective cohort | USA | Rapid-sequence intubation | Concluded that close concurrent and retrospective physician oversight is associated with improved cognitive skills, although the observed changes were not causally linked to the intervention |
| Lee and Kim (2015) | Surveys to EMS personnel | South Korea | Recognition of medical direction in EMS personnel according to qualification level | EMT-basics and first responders have higher need for medical direction in an under-developed EMS system |
| Kim et al. (2015) | Descriptive analysis | South Korea | Report on the process and results of the newly implemented medical direction system | “Patient evaluation” was the most common reason for EMTs to request medical direction |
| Fitzgerald (2014) | Rhetorical genre theory | Canada | Challenges medical direction of paramedics | Hidden values and assumptions (medical dominance) have delayed the adoption of a paramedic self-regulation model in Ontario |
| Millin et al. (2011) | Literature review | USA | Physician roles in EMS | Claimed that evidence for medical direction is evolving. Review of USA literature, excluded other countries |
| Nutbeam (2011) | Commentary | UK | Clinical governance for out-of-hospital providers other than paramedics | Need for clinicians supporting Ambulance Trusts to participate in clinical governance activities |
| Cunningham et al. (2010) | Commentary | USA | Benchmarking medical direction | Limited snapshot of medical direction |
| Webb et al. (2010) | Descriptive | UK | Clinical governance in a correctional institution where doctors, nurses and paramedics provide clinical care | Risk management, with a regular review of clinical incidents is an essential part of clinical governance |
| Munk et al. (2009) | Comparative study | USA | Improvement in EMS quality indicators | Medical direction associated with improved clinical indicators and quality of care |
| Slifkin et al. (2009) | Survey | USA | Assessment of rural-urban differences in medical direction | Recruitment of medical directors is challenging in rural areas |
| Studnek et al. (2009) | Survey of EMS professionals | USA | Quantifies the amount of direct contact between EMS professionals and medical directors | One third of EMS providers had limited medical director contact |
| Busko et al. (2006) | Commentary | USA | Examination of different models of medical direction | Medical direction has not changed to reflect the needs of modern EMS. Non-refereed |
| Barnett et al. (2006) | Commentary | West Indies | Potential physician roles in the Caribbean EMS system | Derivative document |
| Mason et al. (2006) | Survey and interviews | UK | Describes the development of Extended Care Practitioner programs | Appropriate clinical governance is required |
| Porter (2005) | Descriptive | UK | Codes of practice for immediate care doctors in NHS | Medical practitioners, working in the prehospital setting will be under the direction and clinical governance of paramedic services |
| Walker (2005) | Case study | Australia | Paramedic response to meningococcal septicemia | Importance of strong clinical governance processes in a rural paramedic service |
| Tang and Fabbri (2003) | Commentary | USA | Tactical EMS medical direction | Continued development of physician leadership is apparent |
| Knott (2003) | Telephone survey of rural EMS medical directors | USA | Identification of issues faced by rural EMS | Medical direction identified as an issue with integration in EMS seen as a possible solution. Survey restricted to medical directors |
| Baker (2003) | Viewpoint | UK | Implementation of clinical governance | Ambulance NHS Trusts may find introducing clinical governance necessary to avoid potential system failure |
| Gausche-Hill et al. (2003) | Policy resource and education paper | USA | Guidance to medical directors | Describes the development of the federal EMS for Children Program, the importance of the integration, and discussed the role of the emergency physician in the Program |
| Benitez and Pepe (2002) | Descriptive paper | USA | Trauma management | Descriptive account of the role of EMS medical directors in the USA and Canada |
| Peterson (2002) | Commentary | USA | Role of medical directors | Derivative document that provides a clear view on how out-of-hospital EMS fits into the overall emergency medical system in the USA non-refereed |
| O’Meara et al. (2001) | Descriptive | Australia | Formation of a new model for the recruitment and retention of rural paramedic service medical officers | Recommended a more integrated approach to the paramedic service medical officer role. Restricted to one region in rural Australia |
| Stone et al. (2000) | Interviews of medical directors | USA | Baseline of EMS medical oversight in Maryland | Increase in medical director involvement required to meet national job description |
| Robertson-Steele et al. (2000) | Evaluation | UK | State of prehospital care and how clinical governance can address problems of fragmentation | Makes recommendations to improve quality and projects a future course of action |
| Cone et al. (2000) | EMS medical directors in populous cities surveyed. | USA | Assess the availability of physician medical directors for field response | Wide variability in the availability, training and scope of practice of physician field response units |