King County and Medical Direction

[Ginger Medic]

I've been scouring the internet for a few weeks looking up all the information I can find about King County Medic 1. It looks like a great place to work, however one thing that came up was the topic of Medical Direction. In their recruitment video (I can't post a link as this is my first post on this forum), one of the medics mentions that they "talk directly with the doc" and "make their case" then perform their treatment. I've seen several people post that the Seattle Medic One group must OK all treatment with a physician before performing it, including IV's unless the patient is unstable and delaying care would cause death. I have not been able to find any information on their site, nor have I found definitive information from any of the numerous forum boards I looked at in regards to medical direction throughout the rest of King County.

I decided to post this in the hopes that someone here actually works for Medic One and can give me more information. Are you required to contact online medical control on every patient prior to treatment?

Thank-you for any information!

 

[NomadicMedic]

I don't work there, but am very familiar with the system.

Yes, the medics make a med control contact with a doc for everything, present a treatment plan, the doc on the radio or phone confirms what the medic said and approves or denies the treatment.

At Harborview, there is a designated "medic One doc" and a designated "trauma doc" (two separate talk groups on the radio) for consults and orders.

Most of what the medics do is simple, basic ALS (diabetics, Chest pain, etc) and the med control contact is just pro forma. I've seen many instances where the treatment was complete before the medic called to "ask".

 

[RocketMedic]

I find this to be extra-funny- they don't even have autonomy within standing orders? ROFL @ KCM1.

 

[NomadicMedic]

I find this to be extra-funny- they don't even have autonomy within standing orders? ROFL @ KCM1.

Well, they do have some standing orders, they use "Plans" to serve as standing orders for immediate life threatinging conditions, but no real protocols, just a standard of care. If you want to treat a patient with chest pain with ASA, NTG and Morphine, you call and present and say, 'hey, this is what I want to do. " The doc usually agrees ... but they still have to consult with a doc.

Here's a good example of how it works, from the Harborview perspective.
https://depts.washington.edu/pmedic/sites/default/files/ATLS-SFD Talk.ppt

 

[Ginger Medic]

Helpful presentation, thanks! While I'd love the seemingly extra knowledge they have, I don't know that I can get past having to call a doc for permission to do what I'm trained to do.

 

[Summit]

Why do some here perceive it as a lower levelofautonomy to come up with a plan and present it versus following a script?

 

[Ginger Medic]

Why do some here perceive it as a lower levelofautonomy to come up with a plan and present it versus following a script?

In my system I don't follow a script. I have a tool box, and it's at my discretion how I use my tools. The few things that I have to make base contact for are reasonable as they are extremely rare occurrence (Ca++ for hyperkalemia). On nearly every patient, I assess, plan and treat without any outside input until I call the hospital to tell them what I've done, and I'm held accountable for how I've treated my patient.

 

[RocketMedic]

In my system I don't follow a script. I have a tool box, and it's at my discretion how I use my tools. The few things that I have to make base contact for are reasonable as they are extremely rare occurrence (Ca++ for hyperkalemia). On nearly every patient, I assess, plan and treat without any outside input until I call the hospital to tell them what I've done, and I'm held accountable for how I've treated my patient.

This^. Yes, I have protocols, but it is my responsibility and perrogative to implement them.

 

[NomadicMedic]

Not saying its bad or good... it's how they do it, and it works for them. If you want to work in King County, you call the doc.

You get used to it.

 

[Tigger]

Somewhat related: Do all the Medic One programs operate the same way as KCM1? I didn't realize there was more than the one until today, and that Seattle runs its own.

 

[Carlos Danger]

I wouldn't want to have to call an MD for every patient contact. That just seems like a silly, unnecessary PITA and waste of time. I am actually surprised that any large, busy urban system does that.

But that issue really has nothing to do with autonomy. The existence or absence of autonomy is not dependent on the number of times "call for medical direction" appears in your protocol book.

 

[NomadicMedic]

Somewhat related: Do all the Medic One programs operate the same way as KCM1? I didn't realize there was more than the one until today, and that Seattle runs its own.

"Medic One" is the brand name for paramedics in Weatern Washington. Not all the Medic One services are affiliated with the Medic One foundation or with Harborview, but every paramedic in King County works for a Medic One service and MUST attend Harborview. King County Medic One is NOT Seattle, it's the service that provides ALS to south King County and is the only M1 service in KC thats not fire based. (Although the medics are IAFF members and are based in fire stations)

 

[Tigger]

"medic One" is the brand name for paramedics in Weatern Washibgton.

And all of them go through Harborview's program and have that "interesting" scope of practice this oft-talked about here? I see they are all fire-based but are any also firefighters?

 

[NomadicMedic]

See the reply above.

 

[NomadicMedic]

For instance, Mason County Medic One isn't a county agency, it's a private, operated by Olympic Ambulance and the medics can be educated anywhere.

 

[Madclown]

Not trying to take over this thread, but I was hoping someone here could tell me what the starting pay is for an EMT-B at Tri-Med?

I have an interview with them and I can't get an answer. I know it will be a lower pay, but I was told Tri-Med was an excellent service to start out as an EMT.

 

[Scott33]

If you want to treat a patient with chest pain with ASA, NTG and Morphine, you call and present and say, 'hey, this is what I want to do. " The doc usually agrees ... but they still have to consult with a doc.

So in all actuality, KCM1 is probably one of the least progressive systems out there.

 

[Aprz]

How is online medical direction any less progressive than offline medical direction? It is just a different way for the doctor to communicate their orders. The doctor will actually be involved in the call. The paramedics probably have an excellent rapport with the doctors. Looks like an implementation of crew resource management to make sure the paramedic's plan is sane.

 

[epipusher]

How is online medical direction any less progressive than offline medical direction? It is just a different way for the doctor to communicate their orders. The doctor will actually be involved in the call. The paramedics probably have an excellent rapport with the doctors. Looks like an implementation of crew resource management to make sure the paramedic's plan is sane.

Tl;dr, they need permission

 

[Aprz]

Tl;dr, they need permission

You need permission either way. One is just prewritten and the other is not.