How often do you call med control?

rhan101277

rhan101277

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I am just curious about this. I am talking about medicine administration or when you are unsure what is going on and need a second opinion.

ex. I call a couple times a day, month etc.

The one's where you call to get permission to cease efforts do not count.
 
There are two reasons for calling medical control: you have to or you want to. The former depends on your protocols; the latter is a matter of judgment and local custom.

None of us know what's best on every call. When you're not sure what to do, I think it's better to get some expert advice than to risk delivering inadequate or inappropriate care. Your confidence and proficiency should improve as you gain more experience.
 
We have no online control and do not have to call for anything.

Should help be required the first person to call is the watch manager, but this is more for logistical type issues; e.g. immobile patient two floors up or something like that, not really for clinical issues although by all means they are there to help by providing thier Intensive Care (ALS) skillset when required.

It's generally though here that online direction is not really required because if your patient is that sick you don't know how to treat them you should be taking them to the hospital.
 
mgr22 said:
There are two reasons for calling medical control: you have to or you want to. The former depends on your protocols; the latter is a matter of judgment and local custom.

None of us know what's best on every call. When you're not sure what to do, I think it's better to get some expert advice than to risk delivering inadequate or inappropriate care. Your confidence and proficiency should improve as you gain more experience.
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Is it tough, after years of experience, not to get tunnel vision?

Thanks I am just wondering how many times I will be calling when I start out. I have never seen a medic call med control, but they were all really experienced so.
 
Around here, we have pretty liberal protocols, so med command isn't often needed. Most of the time it is to pronounce in the field. When it's not, it is more for a second opinion rather than to ask permission.
 
Only have had need to call twice.

1) ALS Preceptor needed permission to give Fentanyl in a situation that was outside medical directives. (13y/o F, abdo pain)

2) I called last week for permission to bypass my closest facility for a CTAS 2 (usually not allowed unless, STEMI, CVA, or trauma bypass). Pt. was 54 y/o M Hx of liver failur awaiting transplant, kidney disease on hemodialysis, Hep C, etc. etc. Altered LOA no clear cause though I suspected hepatic encephalopathy. Pt. had missed his weekly dialysis that morning. I patched for permission to take the Pt. to a 30 min further drive to the hospital that had dialysis since regardless of the underlying cause, he'd need to dialysis. Dispatch rules wouldn't allow it, but we can override dispatch rules on direction of a Base Hospital Physician.

Other than that, never had to call, but PCP's (BLS) rarely do anyways and we don't have to for any of our standard medical directives.
 
I think the answer is entirely system dependant.

In more progressive systems I have rarey needed to call, if I did it was to do something not by the book. It didn't happen often. But I did get an order to use mag sulfate to sedate somebody one time. (Psych was quite upset about it actually :) )

I have also worked in a "mother may I system," where I was calling so regularly I was wondering why the docs didn't get annoyed and petition for more autonomous protocols. Oh well, "high performance" at its best. Couldn't start an IV unless it was hypovolemia, hypoglycemia, chest pain, or an arrest. It was rather a pain.
 
Whats medical control? No do not call for anything. We treat aggressively based on patient needs with the equipment and large number of meds we carry.
 
As little as possible. I hate getting the 3rd year residents on the line who don't have a clue about what goes on in the field so they play 20 questions and then don't give you orders.

The only time we need to call really is for restraining a pt or pronouncing one.
 
MS Medic said:
As little as possible. I hate getting the 3rd year residents on the line who don't have a clue about what goes on in the field so they play 20 questions and then don't give you orders
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We used to be able to call the emergency department and speak to a doctor for advice but they got rid of it because you might get a house officer who has just graduated, a foreign physician with english as a second language, somebody with less acute experience than you or somebody with no interest or knowldge of how to help an ambulance crew

If we ring up somebody for advice now it's either an Intensive Care Paramedic or one of the Medical Advisors who are emerg consultants
 
MS Medic said:
As little as possible. I hate getting the 3rd year residents on the line who don't have a clue about what goes on in the field.
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This is avoided in our system by having the Base Hospital (our medical direction) have a list of approved, designated Base Hospital Physicians who can answer the phone and provide orders. They have to provide their name and ID Number and the patch is recorded.
 
WolfmanHarris said:
This is avoided in our system by having the Base Hospital (our medical direction) have a list of approved, designated Base Hospital Physicians who can answer the phone and provide orders. They have to provide their name and ID Number and the patch is recorded.
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Thats what we have done; there is a list of approved medical advisors to the ambulance service who are our online consulatation should an Intensive Care Paramedic not satisfy the requirement for advice.

I found some minutes from a Clinical Management Group meeting way back in 2006 which said they (CMG) see themselves as offering three kinds (degrees) of advice to Ambulance Officers:

1. Am with the patient now, need advice immediately (cellphone)
2. Finished a job which went seriously wrong, need advice within the hour (cellphone or pager)
3. Something I'd like to discuss whenever you are free .... (email)

To give you a rough idea; I think #1 which is direct online consult about what to do for a patient now happens about once a day (out of 3,500 ambo's) whereas #2 is really a cover your *** I think we killed him sort of thing which I immagine is fairly rare. #3 is mostly dealt with by Clinical Managers and not the CMG directly any more.

I would personally only consider getting a Medical Advisor on the phone with me right now if I thought my treatment had actually killed a patient or there was some serious clinical risk that needed to be dealt with.

Not that I think it matters personally, but our Medical Advisors are part-time retained emergency or intensivist physicians who practice in the hospital as well as provide advice to the ambulance service. That said they all have an Ambulance pager or cellphone with them but it's often far easier to call the Watch Manager who is an Intensive Care Officer and speak with him, unless like I say, there is some hugely serious problem that requires a doctors input or to activate the CYA mechanisim.
 
rhan101277 said:
Is it tough, after years of experience, not to get tunnel vision?

Thanks I am just wondering how many times I will be calling when I start out. I have never seen a medic call med control, but they were all really experienced so.
Click to expand...

I think complacency is more closely related to experience than tunnel vision is. It's hard to be totally open-minded while assessing every patient. You get used to patterns. The best medics I've worked with take an extra minute or so during patient interviews and assessment to consider differentials more thoroughly.
 
in the state of new jersey, medical control has to be contacted for EVERY ALS patient that you transport to the hospital. EVERY patient.

This is done after all your standing orders are done, and usually more of a "heads up" or a "do you want us to do anything else", and the response from the doc is often "ok, monitor and transport, call us back you you need anything." it's not really "mother may I," it's more like "mom I did all these things, do you think I should do anything else?"

in NYS, you need to call MC if your protocol says you need to (usually after standing orders are given and pt still needs help), or if you are going to a hospital that is on divert (at least that was how it was in Central NY).

also, we don't talk to residents. ever. Attending doctors only, usually experienced doctors who know what does on in the field.
 
We transport to a couple ERs that want a report from you while enroute on EVERY patient. It drives me nuts. It isn't like the people that walk in through the front door are calling to let them know they are on the way there. If it isn't a serious/critical patient, I really can't see the need for us to have to do it, but I digress...

We rarely have to call for orders, although we do have one or two protocols that dictate we call prior to certain procedures. In fact, those procedures are so rarely done, I can't even tell you what they are off the top of my head. The only other time we would have to call is if we have exhausted our protocols for med admin and need more of something (i.e. fentanyl), but even that rarely happens. Typically it would be a situation with a delayed scene time for some reason - prolonged extrication, or something similar.

If we have a pt that is under 1 and the parents have decided they don't want transport via ambulance after calling us, we do have to call for the SOR. We can also call anytime we need a consult. Fortunately we don't have to do that very often.
 
I should mention we call the hospital (called an R40) either on the phone or radio to let them know if we are bringing in a patient who is unstable or critical. This however is not really what I would call "medical control" because the physician or nurse we speak to is not providing us with any advice or instructions.
 
We actually have a decent system here. The University Hospital runs med control for a large portion of the state out of the ED. A 3rd or 4th year resedent is assigned to man the phone all shift and a staff doc is there for back up. We are allowed to ask for staff and by-pass the resident when we feel the need. But it is still a hassle when these residents who don't have a clue what goes on out in the field refuse to listen and give dumb orders and/or you get the one or two staff docs who think we are all imcompetent and will not give reasonalbe orders.

We still have to call radio report into all hospitals we transport to but this is seperate from contacting med control as well.

P.S. One other case we have to call for orders is to neb a pt who has a hx of CHF and COPD/asthma
 
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MS Medic said:
One other case we have to call for orders is to neb a pt who has a hx of CHF and COPD/asthma
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WTF? No disrespect mate but if we had to call up and ask to dish out some salbutamol to patients who have a history of asthma I'd never get off the phone as most asthma patients have a history of asthma :D
 
I don't write the protocols, I just work under them.

The concept is to keep people from nebbing a CHFer. I did not have to do this my last service I worked at and while I understand the intention, in reallity, I feel it inhibits the ability to treat a pt in the field since you get these docs who won't give you orders because (and I qoute) "I can't do an assessment over the phone".
As if that isn't what I did before I called.:excl:
 
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