Retrospective Analysis of Emergency Medical Services (EMS) Physician Medical Control Calls

Abstract

Introduction: Although emergency medical services (EMS) standing-order protocols provide more efficient and accurate on-scene management by paramedics, online medical direction (OLMD) has not been eliminated from practice. In this modern era of OLMD, no studies exist to describe the prevalence of reasons for contacting OLMD. Objectives:The primary goal of this study was to describe the quantity of and reasons for calls for medical direction. We also sought to determine time diverted from emergency physicians due to OLMD. Finally, we hoped to identify any areas for potential improvement or additional training opportunities for EMS providers.Methods: This was a descriptive study with retrospective data analysis of recorded OLMD calls from January 1, 2016, to December 31, 2016. Data were extracted by research personnel listening to audio recordings and were entered into a database for descriptive analysis. We abstracted the date and length of call, patient demographic information (age and gender), category of call (trauma, medical, cardiac, or obstetrics), reason for call, and origin of call (prehospital, interhospital, nursing home, or discharge). Results:The total number of recordings analyzed was 519. Calls were divided into four categories pertaining to their nature: 353 (68.5%) medical; 70 (13.6%) trauma; 83 (16.1%) cardiac; and 9 (8%) were obstetrics related. Repeat calls regarding the same patient encounter comprised 48 (9.4%) of the calls. Patient refusal of transport was the most common reason for a call medical direction (32.3% of calls). The total time for medical direction calls for the year was 26.6 hours. The maximum number of calls in a single day was seven, with a mean of 2.04 calls per day (standard deviation [SD] ± 1.18). The mean call length was 3.06 minutes (SD ± 2.51). Conclusion:Our analysis shows that the use of OLMD frequently involves complex decision-making such as determination of the medical decision-making capacity of patients to refuse treatment and transport, and evaluation of the appropriate level of care for interfacility transfers. Further investigation into the effect of EMS physician-driven medical direction on both the quality and time required for OLMD could allow for better identification of areas of potential improvement and training. [West J Emerg Med. 2020;21(3)665-670.] direction, providing more efficient and accurate on-scene management by paramedics without the need for OLMD. 3 Protocol-based care has been shown to be at least equivalent to OLMD-based care in urban EMS systems. 4 On average a call to OLMD takes approximately four minutes of physician time per call and results in increased on-scene time and delay in arrival to

Covid-19 Pandemi̇ Süreci̇ni̇n Hastane Öncesi̇ Aci̇l Sağlik Hi̇zmetleri̇ Çalişani Ve on-Li̇ne Medi̇kal Kontrolör Arasindaki̇ İleti̇şi̇me Etki̇si̇

“…In the medical controllership system, especially the quality of OLMC plays an important role in the quality of the emergency health service provided to the patient in EMS (Rai et al, 2020). For the effect of OLMC in EMS to work for the patient's benefit, the authorities and responsibilities must be clearly defined, especially in the consultation processes, and especially the process must be maintained in accordance with a certain system structure (Serra et al, 1998).…”

“…In addition, it is obligatory for doctors who will serve as OLMCs to receive some basic training (Husain et al, 2016). The OLMC duty mainly covers EMS protocols and pre-hospital practices, along with professional information for a physician (Rai et al, 2020). In the study, approximately 60% of EMS employees state that the results of consultations with the OLMC for the patient's benefit vary according to the doctor serving as the OLMC.…”