# Please help, can't reach medical control



## Jwhiteside (Feb 9, 2010)

I am an EMT-B, I work for a detention Center, and i have recently ran into a problem. I have a new Doctor working with us, and when ever, i need to get medical direction, this person can never be reached. Now our SOP states that we have to have medical direction to admin certain interventions. Well when you cant get your MD to answer the phone WHAT DO YOU DO NEXT??????????????? you cant just let your patient lay there and die. PLEASE HELP:excl:


----------



## Shishkabob (Feb 9, 2010)

You dont have any standing orders?


----------



## Jwhiteside (Feb 9, 2010)

Our standing orders state that we have to contact Medical Direction.


----------



## MMiz (Feb 9, 2010)

First, welcome to EMTLife!

What are you protocols or standing orders for when you're unable to contact your medical control?  What life-saving drug or intervention would require medical control?  Surely you can administer the ABCs and use your standing orders and directives until you're able to reach medical control.

You need to address why you're unable to contact your medical control.  Whether you or your doctor need a radio system, pager, or whatever else, if it's critical to your job function, then make sure you have it.

I've found that most protocols and procedures state that if you're unable to contact medical control then you follow all protocols as regular standing orders.


----------



## MMiz (Feb 9, 2010)

Jwhiteside said:


> Our standing orders state that we have to contact Medical Direction.


Are you sure those are your standing orders?  Standing orders, protocols, and guidelines are all legal and medical terms that mean different things.


----------



## Veneficus (Feb 9, 2010)

Jwhiteside said:


> I am an EMT-B, I work for a detention Center, and i have recently ran into a problem. I have a new Doctor working with us, and when ever, i need to get medical direction, this person can never be reached. Now our SOP states that we have to have medical direction to admin certain interventions. Well when you cant get your MD to answer the phone WHAT DO YOU DO NEXT??????????????? you cant just let your patient lay there and die. PLEASE HELP:excl:



I am sure a wrongful death suit would probably motivate your medical director to fix the problem though.


----------



## WolfmanHarris (Feb 9, 2010)

This is all at the service level I'm afraid. You need to get with your management and work with them to sort this out. Call it proactive risk management.

For example, my Medical Directives when they call for contacting a Physician (which is only in one or two cases such as exceeding dosage, certain high acuity, low instance intervention) it's written in the directive that if phone contact cannot be made after two tries, and back-up radio patch does not work, the Paramedic is to proceed with treatment and continue to attempt to contact Base Hospital Physician following the treatment to advise them of the circumstances. In other words, contact MD, failing that, proceed and advise after the fact.


----------



## medicdan (Feb 9, 2010)

Consider asking your Medical Director (when you find them), whether there are other suitable places to get on-line assistance, perhaps a local ER Attending...?


----------



## mycrofft (Feb 9, 2010)

*If the doc won't cooperate, tell Custody.*

The facility commander or warden will fire his heiner in a Littlerock minute, after they find a replacement.
Consider geting another job. I'm retiring from 22 years in corrections (County level) and you lose track of "normalcy" in there even more than regular street EMS.


----------



## trevor1189 (Feb 10, 2010)

Try another doc at a hospital. I have had Pt.'s that we couldn't get a hold of med command because they are too busy and we've contacted med command at another hospital even though we weren't transporting to that one.

Also there should be something regarding inabbility to contact medical command, follow the next step in your protocols.

Example, PA ALS Protocols:
In remote or wilderness situations, EMS personnel must make every effort to contact medical command, but resuscitation may be terminated in the field without medical command when the following have occurred:
a. There has been no return of pulse despite >30 minutes of CPR (This does not apply in the case of hypothermia)
b. Transport to an emergency department will take > 30 minutes (This does not apply in the case of hypothermia)
c. The EMS personnel are exhausted and it is physically impossible to continue the resuscitation


----------



## LondonMedic (Feb 10, 2010)

Why is not getting senior support through another route, like another ambo service, not an option?


----------



## mycrofft (Feb 11, 2010)

*OP Whiteside is in another world....correctional facility.*

You can't even call in an ambulance, Custody does it. I have had similar issues but they were due to inadequate commo, not MD's in hiding, and being a friend of Custody and going through them got results, administrative and medical.


----------



## TripsTer (Feb 11, 2010)

LondonMedic said:


> Why is not getting senior support through another route, like another ambo service, not an option?



Nope, afraid not. For whatever service you work for, you have to comply with the protocols of that service and it's M.D. Can't go outside and use someone else's medical director.


----------



## reaper (Feb 12, 2010)

I think they are saying to call 911 and turn the pt over to them!


Most protocols are set up with nice little statements in them, that state if you cannot contact MC, then you follow all standing orders and report to MC as soon as you can.


----------



## Shishkabob (Feb 12, 2010)

Most protocols I know of say that in the event of not being able to reach MC, you can do ALL protocols as if they were standing orders, then to contact MC as soon as possible.  

IE if it says you can only do a crich with MC, but MC cannot be reached, do the crich anyhow.


----------



## mycrofft (Feb 12, 2010)

*Keep safe, save the pt, document like hell. All will be well.*

..................


----------



## emt1972 (Feb 22, 2010)

There must be some form of standing orders other than to contact medical direction... If there isn't the only real option would be to let the corrections division know that 911 needs to be actived (if you are unable to contact medical direction that is) and DOCUMENT everything!!! The times, telephone numbers, etc in which you tried reaching medical direction at, the corrections officer you reported and time, COVER YOUR @$$!!!


----------



## amberdt03 (Feb 22, 2010)

In the event we can't get a hold of our medical director, we are suppose to call the back up medical director, then the 3rd medical director, and in the event we can't get a hold any of them, then we call the emergency room physician of the hospital we are transporting to. Most of the time we can get a hold of our medical director, and he tells us to call the er doc and see what they would like us to do. That is of course, after we have used all standing orders.


----------



## John E (Feb 23, 2010)

*I'm curious...*

what interventions can you do as an EMT-B that even require medical control?

You can't push IV drugs or do any invasive procedures can you?

JohnE


----------



## TripsTer (Feb 23, 2010)

John E said:


> what interventions can you do as an EMT-B that even require medical control?
> 
> You can't push IV drugs or do any invasive procedures can you?
> 
> JohnE



Oral glucose, Nitro, ASA, Combi-Tube intubation...

Not everyone has 'aggressive' protocols.


----------



## John E (Feb 23, 2010)

*Thanks but ...*

I was asking the original poster, should have been clearer.

So let me ask again, to the original poster, what are you allowed to do as an EMT-B that requires medical control?

JohnE


----------

