The Continuation of Medical Control in EMS

[brentoli]

I wasn't trying to take the thread on a tangent. Really I was just trying to get Kiwi to think out his examples more.

Its my opinion that those examples are something EMS should handle. We don't have the follow up resources, but it is our job to document them and begin the course. As I stated, EMS is the only social service some people will ever see. Many people that NEED the intervention in their lives will never get it.

I was reading an article tonight about a woman who had 2 children die in a drowning last year. There were 4 documented calls to child protective services where they investigated, found problems, and never intervened. There are hundreds of those every year in the states, and thousands not documented.

We are medical workers first. We arrive to treat the emergency. Treating ther person is what pulls you away from the pack.

Attention to detail, understanding the person and the cause, and working to resolve the issues are all traits of a professional.

This may become worthy of its own thread, because we are getting pretty far off base from the original questions.

[Kiwiology]

Its my opinion that those examples are something EMS should handle.

Not about handling them or not handling them its about as you touched on, knowing the limits and specality of the place of EMS.

[fiznat]

...but it is not up to me to tell an acutely ill person who is suffering with ischaemic heart disease to lecture them on losing weight, quitting smoking & exercising as well as dietry modifications.

Okay, I guess I understand this point. What I don't understand is what this has to do with whether or not we should be calling on-line medical control?

We should understand what our treatment is doing, how it will benefit the patient, but the patient described doesnt need me farting about talking to someone (mass) debating over what to give them.

They do if there is any question as to whether that medicine should be given or not. If you had to pick between the correct medicine a few minutes from now, or a harmful medicine right now, which would you pick? Not that this particular scenario is that extreme, but there are situations where things aren't so clear. Those are the ones I am talking about.

Give me the tools to treat my patients sufficiently to do that. That is my job. I am not a doctor & can only offer limited treatments. I know the pathophys. I also know my limitations. Medcontrol will not help with either of those.

Medical control WILL help you with your limitations. That is the whole point.

[Kiwiology]

Medical control WILL help you with your limitations. That is the whole point.

How??? Can medical control bring me a radiologist, an intensivist, a CT machine or a cath lab to my truck?

In New Zealand our Guidelines and medical oversight are sufficently broad to allow for full autonomous use of scope of practice and this gives Ambulance Officers freedom to apply thier skills.

Like I say, I have never needed to speak to a doctor or wanted to right-then-and-there. If I am confronted with something totally bizzare that I just have no idea how to treat, what is better; focusing on good ABCDs and taking the patient to the hospital with as much early notification as possible or pissing around ringing up medical control?

There are only so many drugs in that big green bag I sling over my shoulder and I know what each and every one does and what its indications are. I am not an Intensive Care Officer but bet they'd say the same as me.

The only limitation we have here is that we are not doctors and do not have the facilities of the hospital .... which is why most of my patients end up there!

Here's what I went to last week, if you can think of how talking to medical control would help I am all ears:

- Young female with tonsilitis, left at home

- Male in his 40s with inferior STEMI

- Facial burns patient

- 20yof with sinus tachycardia ? smoked a little pot 7/24 ago, left her at home

- Kid about 10 with haematemesis

- Drunk who got into a fight

- Guy who tried to scale a wall on his BMX after 12 beers

- Female in her 20s with a broken ankle

I am sure I forgot one or two in there ....

[aussiephil]

Okay, I guess I understand this point. What I don't understand is what this has to do with whether or not we should be calling on-line medical control?

I said this to highlight that EMS is limited to the tratment of a current acute illness, not address the causes.

They do if there is any question as to whether that medicine should be given or not. If you had to pick between the correct medicine a few minutes from now, or a harmful medicine right now, which would you pick? Not that this particular scenario is that extreme, but there are situations where things aren't so clear. Those are the ones I am talking about.

How many drugs do you carry in your bag that would fit that description?

If we carried a pharmacy, yes I would agree, but there are also publications provided that will tell you the same thing. Med Control is a cop out. Nothing more, nothing less. It is a way for someone to justify their existence & CYA. None of these are good reasons for maintaining med control.

Medical control WILL help you with your limitations. That is the whole point.

Med control will make you lazy. Why remember stuff when someone is on the other end of the line to make the decision for you?

[Kiwiology]

They do if there is any question as to whether that medicine should be given or not. If you had to pick between the correct medicine a few minutes from now, or a harmful medicine right now, which would you pick? Not that this particular scenario is that extreme, but there are situations where things aren't so clear. Those are the ones I am talking about.

Can you give me any examples because I can't think of any??

[WelshMedic]

Med control will make you lazy. Why remember stuff when someone is on the other end of the line to make the decision for you?

Phil makes a good point here, actually. Not sure whether I would have been quite so blunt...but nevertheless....

MedCom is a way of avoiding responsibility. I'm not even really sure why, either. The people who hang around here seem to be pretty knowledgeable and committed. I'm sure most of you are more than up to the job of critical thinking in an acute situation. You don't need anyone to hald your hand for you.

I can't help but wonder (genuinely wonder - this is NOT intended to be an inflammatory comment) whether our US colleagues have so gotten used to being told that they are at the bottom of the chain that they have started believing it themselves?

I agree with Phil and Kiwi - MedCom is a cop out.

WM

[Kiwiology]

Phil makes a good point here, actually. Not sure whether I would have been quite so blunt...but nevertheless....

No point in avoiding the issue at heart really mate, one thing the Kiwi's and Australians do quite well is call a spade a spade.

MedCom is a way of avoiding responsibility. I'm not even really sure why, either. The people who hang around here seem to be pretty knowledgeable and committed. I'm sure most of you are more than up to the job of critical thinking in an acute situation. You don't need anyone to hald your hand for you.

I think medical control in the US is a joint product of the education and legal inadequacies of thier system. That and theyve been using it for so long as you touch on below WM, it's just standard. I am sure there are some who advocate for medical control because it keeps education standards low and means that the minimally educated can never get into a situation where they exceed scope of education because oh well they can just call the doctor and ask him.

I can't help but wonder (genuinely wonder - this is NOT intended to be an inflammatory comment) whether our US colleagues have so gotten used to being told that they are at the bottom of the chain that they have started believing it themselves?

I would say that's about right.

As I've said before, that big green bag I carry only has a limited number of tricks that can be pulled out of it. Nobody can yet give me a good example of when online medical consultation would prove clinically beneficial.

To that end I know my scope of practice very well, it's not hard if you are well educated, well read and keep ontop of the ball so I don't see any need why Ambulance should be ringing up the doctor for something novelle.

[fireflymedic]

I know there are people that I would not trust independent functioning. Until the education changes here, unfortunately, there is a need for EMS personel in the US to be babysat. Sadly there are good medics that could function independent just fine, but there are the stupid ones that do idiotic things that ruin it for the rest of us. Change the education and maybe we'll see some progress.

[JakeEMTP]

I have to ask WM, Kiwi and Aussiephil, do you guys not have any standing orders or can you just practice willy nilly? There are very few interventions I need to call for. I, like you, am capable of assessing my patient's and treating them accordingly. I agree most of the time with what you all have to say. Sometimes though, this "holier than thou" attitude is a little condescending. Not all of the medic's in the US attend medic mills, and function in a "mother may I" system.