Retrospective Analysis of Emergency Medical Services (EMS) Physician Medical Control Calls
UMass Chan Affiliations
Department of Emergency MedicineDocument Type
Journal ArticlePublication Date
2020-04-22Keywords
emergency medical servicesEMS
online medical direction
protocol-based care
Emergency Medicine
Health Services Administration
Health Services Research
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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.Source
Rai B, Tennyson J, Marshall RT. Retrospective Analysis of Emergency Medical Services (EMS) Physician Medical Control Calls. West J Emerg Med. 2020 Apr 22;21(3):665-670. doi: 10.5811/westjem.2020.1.44943. PMID: 32421517; PMCID: PMC7234714. Link to article on publisher's site
DOI
10.5811/westjem.2020.1.44943Permanent Link to this Item
http://hdl.handle.net/20.500.14038/29699PubMed ID
32421517Related Resources
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Copyright : © 2020 Rai et al. This is an open access article distributed in accordance with the terms of the Creative Commons Attribution (CC BY 4.0) License. See: http://creativecommons.org/licenses/by/4.0/Distribution License
http://creativecommons.org/licenses/by/4.0/ae974a485f413a2113503eed53cd6c53
10.5811/westjem.2020.1.44943
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Except where otherwise noted, this item's license is described as Copyright : © 2020 Rai et al. This is an open access article distributed in accordance with the terms of the Creative Commons Attribution (CC BY 4.0) License. See: http://creativecommons.org/licenses/by/4.0/