© 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
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