A working checklist for family office medical readiness: what to audit at every property, how to train household staff without pushing them past their certification, and what physician oversight actually buys.
A family office manages risk the same way it manages everything else: methodically, with a written plan and someone accountable for each piece. Security usually gets that treatment. Medical coverage usually doesn’t. Most family offices I’ve worked with have a first aid kit at the main residence, maybe a nurse on call, and an assumption that 911 and the nearest hospital will handle the rest. That assumption works fine right up until it doesn’t, and by then it’s too late to build the program you needed.
This is the checklist I use when I sit down with a family office to find out what’s actually in place versus what’s assumed to be in place. It covers four areas: residences, household staff, family members across ages, and travel. If your program has real answers for all four, you have something close to protective medicine. If it has answers for one or two, you have the beginning of one.
1. The multi-residence medical audit
Most families I work with don’t have one home, they have several: a primary residence, a place at the lake or the coast, maybe a property overseas. Each one gets treated as a separate security posture, with its own access control and its own staff. Medical readiness should get the same treatment, and almost never does.
A multi-residence medical audit walks through every property the family actually uses and asks the same questions each time: what’s in the medical kit at this location, who on staff here is trained to use it, how far is the nearest emergency department and how long does it actually take to get there (not the estimate, the real drive time, including how it changes with the family’s typical travel pattern to that property), and is there a working communication plan for reaching the medical director if something happens at 2am at the property nobody thought to plan for because it’s only used six weeks a year.
The properties that get skipped are almost always the seasonal ones. That’s backwards. A property the family visits four weeks a year with a skeleton staff is often the one where a medical response is slowest to organize, precisely because nobody rehearses it there.
2. Household staff medical training, matched to what they’re actually authorized to do
Household staff are frequently the first people on scene when something goes wrong, well before an EP team or outside medical support arrives. That makes their training a real part of the medical program, not an afterthought, and it also makes scope of practice the first thing to get right.
An EMT (Emergency Medical Technician) is trained in basic life support: CPR, bleeding control, splinting, basic airway management. An EMT cannot start an IV, administer most medications, or make independent diagnostic calls. A paramedic has considerably more training and a broader scope, including advanced airway management, IV access, and administering certain medications under protocol or direct physician order, but still isn’t authorized to diagnose independently. Household staff without either certification, which is most household staff, should be trained to a clearly defined layperson standard: recognizing a real emergency, basic CPR and choking response, and knowing exactly who to call and what to say. Nobody on a household staff should be operating above the level they’re actually certified for, and a program that quietly assumes otherwise is setting someone up to make a bad call under pressure.
What I look for in an audit is whether every staff member at every property has had this training, whether it’s been refreshed in the last year, and whether they know the specific plan for that property, not a generic one. A household manager who can recite the closest hospital’s name but has never actually driven there during a family stay hasn’t been trained. They’ve been told something.
3. Age-specific medical protocols, pediatric to elderly
A family office often covers three generations under one program: young children, working-age parents, and aging grandparents, sometimes all living across the same set of properties. Each group has genuinely different risk profiles, and a medical program that treats them identically is missing most of what it needs to cover.
For children, that means age-appropriate emergency response (choking and airway management look different in a toddler than in an adult), a clear record of allergies and medications kept current as the child grows, and staff who know what’s different about pediatric care instead of defaulting to adult-scale assumptions. For working-age adults, it usually means travel-heavy risk: jet lag, time-zone medication scheduling, and the cardiac and metabolic risk factors that come with high-stress travel schedules. For elderly family members, it means medication reconciliation (family offices often have an aging parent on five or six medications prescribed by different specialists who don’t talk to each other), fall risk assessment at each property, and a clear plan for chronic conditions that doesn’t rely on staff remembering details from memory.
None of this needs to live in a binder nobody reads. It needs to live with the physician who is actually reachable when a question comes up, which is the same standard that applies to protective medicine generally.
4. Travel medical readiness for the whole family, not just the principal
Executive protection programs are usually built around the principal’s travel. Family offices need to think about everyone: a spouse traveling separately, kids at boarding school or summer programs, an elderly parent making a trip a family office assumed they’d stopped taking. Each of these trips deserves the same pre-travel medical review that a principal would get: known conditions and medications reviewed against the destination, a plan for what happens if something goes wrong somewhere without easy access to quality care, and a way to reach a physician who already knows the traveler’s history instead of starting from zero with an unfamiliar provider in an unfamiliar country.
The liability case for physician oversight
Family offices are adding physician oversight to their risk programs for a reason that isn’t just clinical, it’s also documentation. If something happens and a household staff member acted, or didn’t act, the family office is going to want a clear answer to what that person was actually authorized to do and who signed off on it. “We have a nurse on call” is not the same as a set of standing orders a physician has personally written for that family, at those properties, covering those specific people. One is a resource. The other is a program with a paper trail behind it.
This is also where a lot of programs quietly fail without anyone noticing until it’s too late: a name on a document that satisfies an insurance requirement, but a physician who was never actually involved in building the protocols and isn’t reachable when something happens. I call that a paper medical director, and it’s worse than having no medical director at all, because it creates the appearance of oversight without the substance of it.
What a real family office medical readiness program looks like
It starts with the audit above, done honestly, property by property and person by person. From there, a physician builds standing orders specific to that family, trains the household staff to the level they’re actually certified for and not beyond it, and stays reachable when something falls outside what’s already been planned for. And it gets reviewed on a real schedule, not once at setup and never again, because family composition, ages, travel patterns, and properties all change over time.
This is one piece of a broader approach that extends across executive medical readiness, security team medical direction, tactical medical training, and event medical overwatch, depending on what the family’s program actually needs. The breakdown by audience, including how this applies specifically to family offices versus EP agencies or corporate security programs, is on the who we serve page.
For the terms and questions that come up most often around scope of practice, liability, and how a program runs day to day, the protective medicine FAQ covers that in more depth, including a second part written specifically around family office and event-related questions.
If you want an honest look at what your current program covers and what it’s missing, start with a program assessment. And if you want the credential background behind everything above, that’s on the about page.
Michael Guirguis, MD is a board-certified emergency physician, a Fellow of the American College of Emergency Physicians, and founder of Raven Medical Support Group. Program design for private families runs through family office medical support, with protocols and standing orders written under medical direction.