Module :

Maine EMS On-Line Medical Control

Training Program

Module 2: On-Line Medical Control

© EMRCI 2005 Module 2: On-Line Medical Control

Module 2: On-Line Medical Control

• Objectives– By the end of this module, you will be

able to:• Identify the Roles and Responsibilities of the

On-Line Medical Control Provider

• Discuss the communications modes that can be used to access OLMC

• Discuss the role of protocols in the provision of OLMC

• Identify legal issues associated with OLMC

© EMRCI 2005 Module 2: On-Line Medical Control

Roles and Responsibilities

• OLMC Provider–Working in an ED– Main goal is to provide real time patient

care– OLMC provides real time patient care to

incoming patients– Potentially a distraction

• Should only be consulted when clinician input is needed

© EMRCI 2005 Module 2: On-Line Medical Control

Roles and Responsibilities

• OLMC– Most patients fall into a protocol– Most treatment covered under standing

orders– Patients who require OLMC

• Outside of protocol• Across several protocols• Require protocol care beyond standing orders• Other difficult situations

© EMRCI 2005 Module 2: On-Line Medical Control

Roles and Responsibilities

• OLMC– You are an expert in Emergency Med– May be an expert in prehospital E Med– Two important functions of OLMC

• Authorization of continuing care in protocols– EMT already knows what to do and needs OK

• Consultation for “atypical” cases– Patients outside of protocols– Patients across multiple protocols– Difficult patients

© EMRCI 2005 Module 2: On-Line Medical Control

Roles and Responsibilities

• OLMC– Be available– Know the MEMS pharmicopea– Know the MEMS protocols– Treat the EMS providers as professionals– Recognize the difficulties faced in the

field

© EMRCI 2005 Module 2: On-Line Medical Control

Roles and Responsibilities

• OLMC– TQM of EMS• Provider care• Provision of OLMC

– Record keeping– Education– Follow-up

© EMRCI 2005 Module 2: On-Line Medical Control

Communications

• Contact made through radio or phone

• Advantages and disadvantages to each– Radio– Phone• Land line• Cell

© EMRCI 2005 Module 2: On-Line Medical Control

Communications

• Regardless of method of contact– Recording preferable– Need to write down contact info

• Need to assure reliability

© EMRCI 2005 Module 2: On-Line Medical Control

2 Types of “Call Ins”

• Notification of arriving patients– Usually information taken by nurse– Allows ED to prepared for patient

• Request for medical control– Request for treatment orders–May request advice–May also give preparatory data

© EMRCI 2005 Module 2: On-Line Medical Control

Performing OLMC

• Contact occurs

• OLMC accepts contact

• Case is presented

• Question from provider– Orders requested– Consultation requested

• OLMC gives orders / command

© EMRCI 2005 Module 2: On-Line Medical Control

Performing OLMC

• Orders are echoed – Assures correct orders given– Assures correct orders received

• Echoed orders are confirmed and recorded

• Contact ends• OLMC remains available for

recontacts

© EMRCI 2005 Module 2: On-Line Medical Control

Notification Only

• May be a minor case

• May be a serious case– Providers are busy– Don’t interrupt them

© EMRCI 2005 Module 2: On-Line Medical Control

Medical Control

• Provider requires input from OLMC

• Either requests guidance or order

• If order given–Must be echoed and confirmed

© EMRCI 2005 Module 2: On-Line Medical Control

Permissible Orders

• Protocols drive EMS care

• Use protocols whenever possible

• Indemnified by Maine if you stay in the protocols and maintain records.

• Protocols will almost always meet the patients’ needs

© EMRCI 2005 Module 2: On-Line Medical Control

Permissible Orders

• You determine care– You can order anything you want• Within scope of practice

– I.e. you cannot order perimortem c-section

• Within available equipment / meds– I.e. you cannot order IV beta-blockers

– Orders outside of protocols• One time orders only• Agreed between OLMC and paramedic

© EMRCI 2005 Module 2: On-Line Medical Control

A Special Note for Physician Extenders

• PAs and NPs

• May not give orders outside of protocols– Exception: Supervising physician

immediately available and involved in the medical direction

• Independent Nurse Practitioners–May give orders as a physician would

© EMRCI 2005 Module 2: On-Line Medical Control

Legal Issues of OLMC

• Liability of OLMC

• EMTALA

• Difficult cases for OLMC– Minors– Refusals (RMA)– Intoxicated patients– Restraints– Termination of

resuscitation

– Diversion– Multi-patient

incidents– Frequent users– Critical care

transports

© EMRCI 2005 Module 2: On-Line Medical Control

EMTALA

• Emergency Medical Treatment and Active Labor Act– All patients have the right to a screening

for an “emergency medical condition”– Your liability through contact?• Generally OLMC not held liable• Exception could be a hospital based EMS

system

© EMRCI 2005 Module 2: On-Line Medical Control

When Will They REALLY Call?

• EMS providers rarely need your input

• They know (or have access to) the protocols

• They call in difficult situations

• Often BLS rather than ALS

• You need to help them through this

© EMRCI 2005 Module 2: On-Line Medical Control

Common Difficult Situations

• Specific areas of concern– The uninjured minor (e.g.. in a car

accident) who did not call an ambulance, whose guardian is unavailable, and who doesn’t want care or transport

– The individual who drank 2-3 beers and is refusing care in spite of an apparent injury or illness.

© EMRCI 2005 Module 2: On-Line Medical Control

Other Areas of Concern

• Treat and release

• Individuals in police custody

• Physician on scene

• Mandatory reporting

• Advanced Directive /DNR’s

© EMRCI 2005 Module 2: On-Line Medical Control

Still More Areas of Concern

• Diversion due to ED overcrowding

• Patient “parking” on EMS stretchers

• Mass Casualty Incidents and Medical Command for MCI’s

© EMRCI 2005 Module 2: On-Line Medical Control

End of Module 2

• Click here to e-mail questions