What Happens When the Medical Director Dies?

The unexpected September 20, 2020 passing of prominent emergency physician Craig Manifold, DO, who served as medical director for the National Association of Emergency Medical Technicians (NAEMT), left a large hole in the hearts of his family, friends, and fellow medical professionals. But Manifold’s sudden demise also left a big gap in the Texas EMS sector, due to his deep involvement with San Antonio fire and EMS agencies.

“At the time of his passing, he served as EMS medical director for multiple ground, air, law enforcement, fire-based, private, critical care, and U.S. governmental agencies,” said Manifold’s official obituary. “The Texas Governor’s EMS and Trauma Advisory Committee Medical Director Committee and Texas Preparedness Council also benefited from Dr. Manifold’s expertise and involvement.”

“The death of a colleague is always difficult to deal with, but adding to this tragedy is the fact that Dr. Manifold served as EMS medical director for about 20 different public safety agencies, plus the San Antonio Zoo,” says colleague C.J. Winckler, MD, LP, an assistant clinical professor at UT Health San Antonio and deputy medical director for the San Antonio Fire Department. “It has left a void the medical community is struggling to fill.”

A Pivotal Role

That Manifold served so many Texas agencies speaks to his commitment to effective emergency medicine. Adding to the impact of his loss is the pivotal role EMS medical directors play in Texas. As defined by the Texas Medical Board, an EMS medical director is “a physician licensed by the board who is responsible for all aspects of the operation of an EMS system concerning provision of medical care.”

“In this state all the direction to EMS crews comes from the EMS medical director,” says another Manifold peer, David Miramontes, MD. Miramontes is an assistant clinical professor at UT Health San Antonio who also serves as EMS medical director to numerous agencies, and he worked just across the hall from Manifold’s office. “They play a very big role as to the scope of EMS practices, protocols, and functions in the field.”

The heavy responsibilities associated with this office mean Texas EMS medical directors have to be committed and passionate about their jobs, as Manifold was. “He was available to his agencies 24/7 and always did his best to provide the most useful emergency medical information possible,” Winckler says. “Craig really cared about the quality of advice and direction he gave to his EMS personnel.”

The loss left Manifold’s client agencies scrambling for worthy successors. In the short term Miramontes stepped up, adding his late colleague’s duties to his own medical director commitments. In the long term the contractual nature of the EMS medical director position means a lot of headhunting will be taking place in Texas soon. (In some instances the affected agencies have deputy EMS medical directors in place who could be promoted.)

Thanks to the effort of Miramontes and others in the Texas emergency medical community, none of Manifold’s former agencies have been left without EMS medical direction. Still, the loss of an acknowledged titan in the industry is not something that can be readily remedied.

“If there’s a lesson to be learned by Dr. Manifold’s sudden passing, it is the necessity of having a detailed succession and management plan to deal with such circumstances,” says Miramontes. “It also helps to have another outside fire or EMS agency step up to help with related necessities such as preparing a fire department funeral with full honors, since having to do this in-house when coworkers are grieving is very emotionally demanding.”

James Careless is a freelance writer and frequent contributor to EMS World.