# Medical Control



## Genesis (Feb 14, 2011)

I am an EMT-B student (just started a few weeks ago) and my book doesn't do a good job of explaining medical control.

When we call medical control, who exactly are we contacting? The ER Physician? Is there someone specifically designated as medical control? Where are they? Also, does this differ between EMS systems?

Sorry about all the questions...just want to understand it better.


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## medicRob (Feb 14, 2011)

Genesis said:


> I am an EMT-B student (just started a few weeks ago) and my book doesn't do a good job of explaining medical control.
> 
> When we call medical control, who exactly are we contacting? The ER Physician? Is there someone specifically designated as medical control? Where are they? Also, does this differ between EMS systems?
> 
> Sorry about all the questions...just want to understand it better.



Usually an Attending Physician or a Resident, if not our own medical director (depending on circumstance). For instance, if my protocols say that I am allowed to give up to x amount of a pain med, yet I believe another dose is needed, I would contact online medical control, state my case to the physician, and wait for him to either say go ahead or no. 

Medical control is pretty much the same nationwide in EMS systems, the only thing that differs are the protocols and the scope. For the most part, we all contact either an attending or a resident in the receiving hospital.


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## JPINFV (Feb 14, 2011)

Yes it differs and the answer as to who you're talking to is "it depends on the system."


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## Genesis (Feb 14, 2011)

medicRob said:


> Usually an Attending Physician or a Resident, if not our own medical director (depending on circumstance). For instance, if my protocols say that I am allowed to give up to x amount of a pain med, yet I believe another dose is needed, I would contact online medical control, state my case to the physician, and wait for him to either say go ahead or no.
> 
> Medical control is pretty much the same nationwide in EMS systems, the only thing that differs are the protocols and the scope. For the most part, we all contact either an attending or a resident in the receiving hospital.



Thanks for explaining. I think I got it now.


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## Amycus (Feb 14, 2011)

I have yet to use Med Control in the past year I've worked as a EMT-B, but at least in MA where we use the CMed radio system to contact the hospitals, instead of requesting an entry note, we just request Med Control at that facility, and either an attending or resident would pick up the radio and respond to us. Granted though, Charcoal is our only Med Control option, everything else is standing.


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## MassEMT-B (Feb 14, 2011)

Amycus said:


> I have yet to use Med Control in the past year I've worked as a EMT-B, but at least in MA where we use the CMed radio system to contact the hospitals, instead of requesting an entry note, we just request Med Control at that facility, and either an attending or resident would pick up the radio and respond to us. Granted though, Charcoal is our only Med Control option, everything else is standing.



Yea its nice. The only bad part for me is my company operates in MA/RI and I am certified in both. RI has you contact Med Control for a lot more. Granted RI also has a bigger scope of practice for EMTs.


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## Amycus (Feb 14, 2011)

Yeah, I can only imagine. I'm cross certed for MA/NH, and NH has even more leeway than MA does. Hate that NH offers field c-spine clearance, combi/king tubes, etc...and in MA...nothing.


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## JPINFV (Feb 14, 2011)

Err... have you read the protocol for c-spine? It basically gives providers as much rope as they're willing to take in regards to decide if cervical spinal immobilization is indicated.


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## MrBrown (Feb 14, 2011)

Paramedics work under the legal instrument of delegation to use certain pieces of clinical equipment and prescription/controlled drugs as (unlike in some countries) in the US they do not have independent ability to prescribe/administer/perform.

What the delegated standing order does is allow them to use X drug or clinical procedure in Y situation and if so, give up to Z dose before calling for an order from the registered practitioner to exceed the standing order.

Now here in New Zealand we have no medical control and do not have to call for anything.


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## TransportJockey (Feb 14, 2011)

In NM the system I worked in had you call the receiving hospital. In CO you had to call the hospital your service medical director worked at. Here in TX we call our local hospital.


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## mgr22 (Feb 15, 2011)

Medical control can be a stand-alone department, not necessarily affiliated with the receiving hospital. You might speak with a medic or nurse, instead of a doctor. Policies and procedures vary by region.


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## LeclairEMSI (Feb 16, 2011)

I am an ED Technician in a Level 2 Trauma Center.  It is the responsibility of the ED Tech to answer the radio.  We gather the information and if the caller needs medical direction we will get the provider.  Very often the provider will verify the caller has followed protocol before giving online medical orders.


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## Madmedic780 (Feb 20, 2011)

You can call OLMC for guidance if you're not sure what to do, or if you feel the situation doesn't match your given protocols.

I have long transport times so I've mostly seen them used for permission to exceed our standing orders on meds.


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## Genesis (Feb 21, 2011)

So is there a designated phone in the ER that is obviously very important to answer if it rings or do they have radios? Now I'm curious about how each service operates.


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## TransportJockey (Feb 21, 2011)

Genesis said:


> So is there a designated phone in the ER that is obviously very important to answer if it rings or do they have radios? Now I'm curious about how each service operates.



That's another part that the answer is 'it depends'. NM we used radios, CO cell phones (biophones), TX cell phones or radios. And that's not state wide, just the systems I've worked in.


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## medicdan (Feb 21, 2011)

Amycus said:


> I have yet to use Med Control in the past year I've worked as a EMT-B, but at least in MA where we use the CMed radio system to contact the hospitals, instead of requesting an entry note, we just request Med Control at that facility, and either an attending or resident would pick up the radio and respond to us. Granted though, Charcoal is our only Med Control option, everything else is standing.



You can certainly use medical control for more in MA. I've used them for refusal clearance, extra doses of Epi (if patient has already taken their own PTOA, to give a third), nitro following an ED drug within 48, etc. If transporting, medical control likely comes from the receiving facility, otherwise special protocols etc come from a facility where we have an affiliation agreement and designated medical director (one hospital per region).   

In MA, you certainly can used CMED for medical control consultation, but that process just takes a long time, and not all services have it programmed into their portables (most have it only in the radios in the back of the truck, making it impossibly to use on-scene), so for speed, clarity of discussion and convenience, I use cell phones most often (either department-issued or personal). 

One of the services I work for consults a medical control physician before some non-emergent ALS-transfers because it allows us to carry medications and equipment inter- and intra-facility not generally considered ALS-level. In those cases, we call a specific non-emergency medical control number, and sometimes wait a few minutes to speak to a physician. 

One of the reasons your book doesn't describe this well is, as others have said, because it differs so much regionally, and even by service or level of care. 

Please also be advised, in some systems, if you seek medical control consultation at a facility different than where you transport to, you may need to go to the hospital where the physician is in order to get a signature, after the call. 

Hope this helps!


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## dixie_flatline (Feb 21, 2011)

As you can see, Med Control is a _very_ jurisdictional thing. The basic gist is that you use something (generally a radio, possibly a telephone) to contact a designated entity with the necessary clearances and abilities to direct you as needed.  

It might be important to draw a line between Medical Control and Other Hospital Communications.  Many areas require an incoming ambulance to notify the receiving facility while en route ("This is medic 16, en route to your facility with a 45 year old female patient involved in a rollover MVA.  Negative on LOC, vitals are XXXXX.  Pt complaining of neck and shoulder pain. Currently about 7 minutes out." - something like that).  In Maryland, these communications are often handled by a nurse at the triage desk.  And yes, at the hospitals I run to anyways, there is an actual radio located at the desk.

Medical control, on the other hand, requires a doctor (I've never spoken to a PA or NP or anything) to evaluate the patient's condition as presented by you, and your proposed treatment, and make a clinical decision.  At the Basic level this isn't a common occurrence in many areas, but depending on local protocols you might find yourself talking to a doc more regularly.

Maryland has a state-wide EMRC system that can be used for this.  Some places, like Shock-Trauma, require a consult (not just a notification) before they will accept an emergent patient.  





> *EMRC Communications (Emergency Medical Resource Center)* – The EMRC medical channel radio communications system links EMS providers in the field with hospital-based medical consultation.  The EMRC operator receives calls from EMS providers in the field, directs the provider to the appropriate med-channel, and establishes a patch to the appropriate medical facility.  Consultation facilities and multiple hospitals can be patched into a single consultation.  The EMRC plays a critical role that aids in ensuring a coordinated response to major incidents and catastrophic events.  The EMRC can also be accessed by local and 800-service dial telephone.


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## JPINFV (Feb 21, 2011)

...and in some places, EMTs do not have access to online medical control.


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## CAOX3 (Feb 21, 2011)

JPINFV said:


> ...and in some places, EMTs do not have access to online medical control.



Really..... interesting.

Why wouldnt they have access to med control?


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## JPINFV (Feb 21, 2011)

It's really wasn't that much needed. All 911 calls had a paramedic first response, so the only time that EMTs (who are mostly limited to oxygen anyways for medical calls) would need it was on IFTs, and if you're an EMT on an IFT thinking about medical control, you need paramedics or to expidite transport to the closest ED anyways, instead of playing around with medical control.


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## lightsandsirens5 (Feb 21, 2011)

CAOX3 said:


> Really..... interesting.
> 
> Why wouldnt they have access to med control?



No cell service. And no radio service. Like out in the boondocks where I work.


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