Med Control

How do you recieve treatment orders? Please explain in your post.

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firemedic7982

firemedic7982

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What type of medical control does your system have?
 
Standing orders, followed by contacting the base doc for follow ups.
Everytime.
No exceptions.
:rolleyes::glare:
 
Delegated what Texas?
 
Offline (standing orders) We have online available or one of those "oh crap" moments.
 
We have our standing orders/protocols offline written in a fancy little book and we have online, whoever the receiving doc is, is considered med direction for online control. We have a couple procedures and meds that our standing orders say require online med direction to administer (labetolol is one). Doesn't every EMS textbook ever written talk about an effective system must combine online and offline med direction?
 
bstone said:
Delegated what Texas?
Click to expand...

Delegated practice in Texas boils down to if a Doctor teaches you something, you can do it no matter what level.

If your med control wants a Basic to do open heart surgery, he has the right to decide so.
 
Linuss said:
Delegated practice in Texas boils down to if a Doctor teaches you something, you can do it no matter what level.

If your med control wants a Basic to do open heart surgery, he has the right to decide so.
Click to expand...

Obviously that'd have to be an actual class. Not just some doctor explaining what he's doing while you do your clinicals.
 
HotelCo said:
Obviously that'd have to be an actual class. Not just some doctor explaining what he's doing while you do your clinicals.
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No.


If your medical director says "This is how you do brain surgery... now go at it", then you go at it.


You operate off of their medical license.


This gives a lot of leeway to the more progressive agencies here that end up inducing hypothermia for cardiac arrest and the like.
 
re

Standing orders here also in nor-cal. We do have a few odd ball things that require direct BHPO though.
 
Most is offline standing orders, but depending on the situation/call/event we've got the lovely online med control.
 
HotelCo said:
Offline (standing orders) We have online available for one of those "oh crap" moments.
Click to expand...

Same here. I don't know if it is a state wide thing or jusy my county though. (I am learning that I live in a strange county when it comes to EMS. It is quite different than tha rest of the state.)
 
Standing orders only, at least as a basic.
 
Most of our stuff is standing orders, pre-radio.
Contact receiving facility, or closest medical control for further orders.
 
Mainly standing order here too. There are some medical control options, however 95% of what I do is covered under standing order. Something I need to call for for example would be calcium chloride in suspected hyperkalemia. I've never been told no, however we are required to call before tx, although our medical director doesn't really push the issue.
 
We have standing orders and online protocols.
 
Standing orders for the most part. Interestingly enough when I worked in So Cal there wasn't even standing orders for the most part, only county policy/protocol regarding patient destination, DNR, AMA, etc.
 
lightsandsirens5 said:
Same here. I don't know if it is a state wide thing or jusy my county though. (I am learning that I live in a strange county when it comes to EMS. It is quite different than tha rest of the state.)
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Its not just your county. We have standing orders and online here in Clark County also.

How different is your county from the rest of the state? I had heard that we had a different set of protocols here but now that I've been through the training that turns out to have been a bit of misinformation.
 
Both MD and PA protocols are written with standing orders and then there is the Med Command only line... where we need to consult prior to administering a certain medication or more of a medication already given.
 
Just to clarify a misconception, "Delegated Practice" is not a style of medical control. Systems in Texas still have to have medical control of some sort, whether it be by OLMC or standing orders. All Delegated Practice means is that the MD is free to put anything they want into those orders without the state or local authorities dictating what they will be. Consequently, you get significant variations in clinical sophistication from system to system in Texas. Some carry little more than pre-filled ACLS meds and couldn't read a 12-lead if their lives depended on it. Others have a three or four page drug list, routinely interpret 12-leads, start central lines, and administer antibiotics. It's all up to the MD. But again, having "Delegated Practice" does not necessarily mean that your system is any better than any other system, or that you do not need orders.

I have worked in a fire-based EMS system in Texas where you literally did not do anything without first contacting medical control. They read your strips for you and gave you orders for everything from IVs to defibrillation. It was a milestone day when they start letting us start an IV without first talking to a doctor. On the other end of the spectrum, I have worked for a county third-service EMS in Texas where, if we called to talk to a doctor, it was taken as a sign that you didn't know what you were doing, and they would seriously question your competency. The only "standing order" was a single paragraph stating that you were authorized to do anything you deemed medically necessary, within accepted standards of medical practice. The two systems were only separated by one county, yet the difference in sophistication was night and day.
 
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