Medical Control

[Illini_emt]

Hey Guys, glad to be a part of EMT Life, This is going to be a dozzy so if I dont make sense please let me know.

First off I am a part of a Volunteer Amb service in the middle of nowhere, the service has been around since the old hurst days, where they were apart of the EMS region base out of a hospital approx 40 miles away. We will call this hospital Mercy (Not its real name, but lets go with it.) Present day its a Level 1 Trauma and Level 3 Prenatal, one of the best in the state. But now there is a closer hospital only about 8 miles away where we transport a majority of our patients to. It created a Regional EMS of its own a few years back and most of the AMB services in the area switched its medical control to them (we will call them General) General is just an Acute Emergency Room, no Trauma Level, but all in the same its an ok ER. But to rap up the local history lesson, my service, the only one out of 12 in the county, did not change to the New EMS System and kept with Mercy as our Medical Control.

Well I was on a call a few months back and for a BLS service was one of the first times I had to call into Med Control I was leading a run for a 25 yr Male pt with a insect bite, showing the signs of anaphylaxis shock, and called into Mercy via ALS line for Medical Direction/Permission to administer .3mg epi, via auto injector that our AMB carries with strict rules to call in first before administering. ( :wacko: )

Well they told me over ALS line to contact the receiving hospitals ALS line for there doctor to give the order, they were not going to be the receiving facility so I should check with them, said the ECRN. So I hung up and called Generals ALS, They told me that they are not my medical control, that I shouldn't have called them with that question, and refused to give me and answer, all while my pt was still lying there with an O2 Sat of 95% on 15L NRB and I was starting to get the airway kit out.

Called back to Mercy, and they told me again to contact receiving facility for Direction. And By that time, I had received my ALS intercept from the City unit, where I got yelled at for not pushing the epi.

Other then being a rather long rant, (Which I do apologize for) I was wanting to get some other none area tainted EMTs views on this. Thanks guys.

 

[FF-EMT Diver]

We recieve orders from what ever hospital we are enroute to/ whatever Dr. is on, Thankfully our standing orders are large so we rarely need to call other thanto give report.

 

[mycrofft]

I'd have been tempted to hand he injector the pt...kidding

Dueling base stations, opposite of the old rural EMS days. Squads used to shop hospitals by radio to get the orders they wanted.

Check your protocols and use them. Write this up, with time date and any names you might know for sure. Keep a copy for yourself, turn in a copy to your boss. Incidents like this point out areas for improvement, and sometimes people who need a little more training or a little more sleep.

 

[theoriginalmslt]

in chicago, immc's system, our rules are pretty strict on taking orders only from our resource hosp. the other ed's we only call to give reports when were en route, but if they give an order thats outside our smos we have to call the resource hosp and ask them.

 

[KEVD18]

you need to check your local protocols. somewhere, there is an official document/rule/law/administrative requirement that's states whether you get your olmc from one hospital regardless of where you're transporting too; or whether you derive med control from whatever hospital you're going to. both systems are in use around the country and i have no intention of looking it up for you.

now, when you have the above information, file a complaint against whomever was at fault. one of those facilities was in the wrong. figure out who and hang them. kick it all the way up to the governors office if you have too. be sure to play up the severity of an anaphylactic reaction and how you really don't have the time to be doc shopping.

btw, i hope you kept records as to who you spoke to at the er.

 

[Veneficus]

The art of being a trouble maker

First, just to reassure you this problem has come up before. I suggest putting your concern in writing. Once you do that it assures it will be looked at. I would send it to the medical director since that is where the problem originates from.

Be as specific as possible. Most important be truthful! Once people start looking at your complaint, they will gather all the information on it. Your report, the ALS report, the hospital’s records any recorded communications, and other witnesses views.

If you lie or embellish parts, it will call into question not only your integrity but also your ability as a provider. This may have farther reaching consequences than you want. Also, you have discovered a legitimate point for improvement in your system. Don’t make it personal. It may have been a simple oversight on one or two people’s part. They both may have been physicians with legitimate issues of why they wanted you to call the other one. It is also possible somebody other than a physician that you will have to work with regularly did not understand the procedure.

Make sure when you write this you include as many details as you can. Times, people you spoke with, etc. Also be professional, this is a formal complaint/submission. Avoid being accusatory or otherwise subjective.

In my past experience with this, often it is the medical director and the director of the local EDs that have to work this out. Nobody is perfect or can see all the possible situations that may come about. I doubt it was a pissing contest between the 2 facilities.

Make sure your goal is always to address the problem, not righteous indignation.

 

[Brandi]

we call the hospital that we are transporting to. But we dont have to call that often.

 

[Jon]

In PA, the push is for destination-based command... that means that for traumas, we call a trauma center, and when the patient wants to go to XYZ hospital, we call XYZ hospital and talk with the doc if we need to. Every ALS service, and almost all BLS services, must have some form of medical command. We call our own command facilities for refusals, as well as when our command facility is our destination or possible destination.


The call sounds like it was a mess. I think that the situation needs to be elevated about your pay grade (so to speak)... I'd have documented it and passed it off to my supervisor... the supervisor, region, and the assorted ED's need to sort this one out.

 

[Flight-LP]

I agree with most responses, however, before you go running off to Springfield* or your medical director, I'd write it up and submit it to your supervisor. One of the great things about your next higher up is that they can fight your battles for you. Write it up and let them deal with it instead of going off on a crusade that can and probably will get personal due to emotional bias of experience. Yes, technically one of the facilities was wrong if in fact they were responsible for playing "mother may I" with your BLS service.

However, if its any consolation, SQ / IM Epi is not likely to resolve true anaphylaxis because of systemic circulatory collapse. In other words, if you truly had an anaphylactic patient, they needed IV Epi.

This is why I am so thankful to have never worked for any service that required on-line medical control. Too much of a pain in the a$$.

(*-Besides, you may not have a governor for long anyways )

 

[BossyCow]

We have run into this with a neighboring district. The extremely small rural hospital that they transport to is barely more than a clinic. The attending ER physicians refuse to answer medical control questions if the actual MPD is not on shift. Instead the MPD for the adjoining district must be contacted.

 

[redcrossemt]

In regards to what medical control facility to use, we are required to contact the hospital we are going to. If the patient's/our choice of hospital refuses to take the patient (e.g. they recommend going to a trauma center or closer hospital), the new receiving facility gets report and provides medical direction.

We have a couple freestanding ER's (without inpatient beds) and urgent care facilities we transport to. For these facilities, they are required to be associated with a fully-capable facility whom we contact for OLMD.

 

[downunderwunda]

With the training EMS, especially Paramedics have to take, why do you need medical control to relayorders for a pt they have not seen.

Can the see the perfusion status, the overall visual picture of the pt? No. YTou hav protocols, pharmacologies, training & hopeflly more than half a brain. Medical control should be left in hospital. If they want to do prehospital, let them work on an ambulance.

EMS is & always will be a PROFESSION of its own. Medical control, other than in a protocol advisory capacity should be disbanded.

Play safe

 

[VentMedic]

Because of this

With the training EMS, especially Paramedics have to take,

training with little education...

and

EMS is & always will be a PROFESSION of its own.

EMS alienating itself from the professions of medicine...

Medical Control or orders from the hospital are necessary sometimes.

 

[boingo]

We are refering to *** backward U.S. EMS, not the same as a well educated professional EMS as in OZ, fair dinkum...

 

[medic417]

I am so grateful that I do not have OLMC. If the patient needs it we do it. I really can not grasp denying even basics the right to use an epi-pen or even to draw epi in a syringe and administer. ( $3 or less compared to epipen +-$75 ) If the patient is haveing a reaction airway is being threatened, treat them. Wasting time contacting someone to do what is needed is just a bad plan.

 

[EMTWintz]

I am wondering, does your epi come in a red bag? The only reason I ask is cuz my BLS squad has been cleared to admin. epi, nitro, asa from a red bag with the protocols giving you the option to use clinical judgement or call med control. Which ever you are more comfortable with. Side note we were cleared to do rec. this 2 years ago and still have not rec'd said meds. Also may I ask what part of IL you are in?

 

[rhan101277]

We recieve orders from what ever hospital we are enroute to/ whatever Dr. is on, Thankfully our standing orders are large so we rarely need to call other thanto give report.

Yes Georgia seems like a nice place to work. Although you have to be at least a EMT-I. Would I have to take the whole EMT-I course, or could I just take certain sections since I am a EMT-B already.

Mississippi where I am hardly lets basic's do anything. We can't even use a pulse oximeter or a glucometer. But yeah if i get a job in Alabama I can. There are some states that have those ana-kits to for anaphylaxis, but again Mississippi is in the back of the bus on protocols.