2. Module : Maine EMS On-Line Medical Control Training Program Module 2: On-Line Medical Control

3. © EMRCI 2005Module 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

4. © EMRCI 2005Module 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

5. © EMRCI 2005Module 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

6. © EMRCI 2005Module 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

7. © EMRCI 2005Module 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

8. © EMRCI 2005Module 2: On-Line Medical Control Roles and Responsibilities OLMC –TQM of EMS Provider care Provision of OLMC –Record keeping –Education –Follow-up

9. © EMRCI 2005Module 2: On-Line Medical Control Communications Contact made through radio or phone Advantages and disadvantages to each –Radio –Phone Land line Cell

10. © EMRCI 2005Module 2: On-Line Medical Control Communications Regardless of method of contact –Recording preferable –Need to write down contact info Need to assure reliability

11. © EMRCI 2005Module 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

12. © EMRCI 2005Module 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

13. © EMRCI 2005Module 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

14. © EMRCI 2005Module 2: On-Line Medical Control Notification Only May be a minor case May be a serious case –Providers are busy –Don’t interrupt them

15. © EMRCI 2005Module 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

16. © EMRCI 2005Module 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

17. © EMRCI 2005Module 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

18. © EMRCI 2005Module 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

19. © EMRCI 2005Module 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

20. © EMRCI 2005Module 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

21. © EMRCI 2005Module 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

22. © EMRCI 2005Module 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.

23. © EMRCI 2005Module 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

24. © EMRCI 2005Module 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

25. © EMRCI 2005Module 2: On-Line Medical Control End of Module 2 Click here to e-mail questions