The Continuation of Medical Control in EMS

[Kiwiology]

Correct me if I'm wrong but I thought you mentioned either AK or Dust being ill and not able to post much these days?

<HUMOUR>

Yeah Rob (Dust) is a broken down wreck, but, knowing him, it's just a ploy to get some 20 something blond live in nurse move in with him

</HUMOUR>

Seriously, he is a good bloke

[WelshMedic]

<HUMOUR>

Yeah Rob (Dust) is a broken down wreck, but, knowing him, it's just a ploy to get some 20 something blond live in nurse move in with him

</HUMOUR>

Seriously, he is a good bloke

Yes, he is! The live in nurse would have to be a real tough cookie to put up with him though

[armymedic571]

As Dwayne said, this is a very interesting topic.

I recall reading an article posted on this forum just recently, written by Bryan Bledsoe in which he discussed doing away with on-line medical control.

Our brothers with the funny accents (or do we have the funny accents?), make a very astute and valid arguement, that any well trained provider should be abe to practice their profession without permission or distraction from Medical Command.

The main difference here is education. Some of us, have been blessed with making the right decisions on which school to go to, to finish our degrees, and to work for progressive, professional orginizations. Not all of us have this, and that is where we find ourselves.

I will agree with Fiz that online med control should be available, but can honestly say that the only reason I call for command is because I have to by our policy, and not because I cannot manage my patients. I would presume, that this is the same case in a majority of the people on this Forum.

I think there is a large disparity from those of us on opposite sides of the globe, simply based on the way our educational and liceansing systems works. The fact that these systems are not only different in regards to requirements, and level. They can be further complicated by by region, state and even service. Because there is not one set standard, although a shame....we are all not craeated equally.

The bottom line here is that it is the personal responsibility of the provider to continue to learn, be compitent, and be proficient. It is the managements and Medical Directors job to set boundries, but most importantly to trust their proviers to do their jobs. If this is not the case, why are we employeeing these people?

Cheers everyone.

[WelshMedic]

As Dwayne said, this is a very interesting topic.

I recall reading an article posted on this forum just recently, written by Bryan Bledsoe in which he discussed doing away with on-line medical control.

Our brothers with the funny accents (or do we have the funny accents?), make a very astute and valid arguement, that any well trained provider should be abe to practice their profession without permission or distraction from Medical Command.

The main difference here is education. Some of us, have been blessed with making the right decisions on which school to go to, to finish our degrees, and to work for progressive, professional orginizations. Not all of us have this, and that is where we find ourselves.

I will agree with Fiz that online med control should be available, but can honestly say that the only reason I call for command is because I have to by our policy, and not because I cannot manage my patients. I would presume, that this is the same case in a majority of the people on this Forum.

I think there is a large disparity from those of us on opposite sides of the globe, simply based on the way our educational and liceansing systems works. The fact that these systems are not only different in regards to requirements, and level. They can be further complicated by by region, state and even service. Because there is not one set standard, although a shame....we are all not craeated equally.

The bottom line here is that it is the personal responsibility of the provider to continue to learn, be compitent, and be proficient. It is the managements and Medical Directors job to set boundries, but most importantly to trust their proviers to do their jobs. If this is not the case, why are we employeeing these people?

Cheers everyone.

Hi AM,

You have made a valuable contribution to a great thread. First things first (to start off on a light note): You, my friend, have a funny accent with a twang in it. I, however, speak the Queen's english which is the only true form, my old chap!

Education, Education and Education...we can't emphasize it enough, can we? Dust commented to me (in reply to a comment about the lack of confidence in EMS):

I think that's a great observation. It is indeed a very common factor in US EMS. The original medics in the US were founded on the concept of being the so-called "eyes and hands of the physician". That mindset has persisted all these years, just below the surface. Way too many medics have never been forced to step outside of their flowchart protocols and use their heads to think for themselves. They are still living the "eyes and hands" life from the 1970s. And honestly, that's probably a good thing in most of the country.

Whilst this is undoubtedly true, I think there are other factors which perpetuate the situation in today's EMS.

1) Volunteerism: when someone is already doing 2 paid jobs and volunteering in EMS, how do they find time for professional development? They don't.

2) When a Fire Monkey is using EMS as a stepping stone then he/she also isn't going to hit the books much.

3) Educational standards need to be reviewed and reset. ALS should be the domain of someone with at least a Bachelor's Degree. It doesn't matter which country you are in, or which system. That level of critical thinking needs education.

As far as your comment on personal responsiblity for keeping up-to-date: Amen, brother!

Take Care,

WM

Edited March 26, 2010 by WelshMedic

[JakeEMTP]

Phil, WM and Kiwi, The way you guys function is exactly the way we do it. We have a set of SOP's and protocols in which to operate. They are flexible and I can follow the whole algorithm or none of it or enough of it to manage the patient. On the few times that I would need to call Medical Direction is if there was something not in the protocol I wanted to do or try. I like the idea of having a Physician I can call to consult. They're the one's with the 10 years of medical education. Because I function under a MD's license, if we want to operate outside our scope for whatever reason, they must be contacted. Other than that, I have the flexibility to treat the pt. as I see fit, according to standing orders and my assessment of the patient. I hope that makes some sort of sense to you.

My intention was not to get into a pissing contest. I was asking out of curiosity as to how it worked down under and over there. I hope I didn't offend as that was not my objective, I've been a fan for years!

I submit to the fact the US EMS system is in dire need of a complete overhaul. I can only hope that someday the education requirements will advance to that of the rest of the modern world.

And yes Kiwi, you did mention LAFD and it's ilk!

Edited March 26, 2010 by JakeEMTP

[aussiephil]

Phil, WM and Kiwi, The way you guys function is exactly the way we do it. We have a set of SOP's and protocols in which to operate. They are flexible and I can follow the whole algorithm or none of it or enough of it to manage the patient. On the few times that I would need to call Medical Direction is if there was something not in the protocol I wanted to do or try. I like the idea of having a Physician I can call to consult. They're the one's with the 10 years of medical education. Because I function under a MD's license, if we want to operate outside our scope for whatever reason, they must be contacted. Other than that, I have the flexibility to treat the pt. as I see fit, according to standing orders and my assessment of the patient. I hope that makes some sort of sense to you.

My intention was not to get into a pissing contest. I was asking out of curiosity as to how it worked down under and over there. I hope I didn't offend as that was not my objective, I've been a fan for years!

I submit to the fact the US EMS system is in dire need of a complete overhaul. I can only hope that someday the education requirements will advance to that of the rest of the modern world.

And yes Kiwi, you did mention LAFD and it's ilk!

Jake,

great post. I think my last was one that showed I wasnt wanting a pissing contest either. Put simply, IF we are given the right education, we are given the opportunities for professional development, there will be little or no ned for any med control. I resent the notion that I should have to seek direction in my practice of pre-hospital medicine. As welsh stated, threre are a number of things that contribute to this, (no offence intended to thosese who are vollies) vollies, how can I expect someone to pay out money for learning & development as well as turning up for nothing? & the whole fire monkey thing (maybe that is the reason to keep med control - monkey see monkey do), what is their focus, providing real EMS or using it as a reason to get more pay & benefits. As I said, there are those who are posting here who occasionally use med control but prefer to use their brains, but there are those who forgot long ago how to do that, instead prefering to lean on med control. That needs to be stamped out.

Phil

[DwayneEMTP]

Dwayne, mate,

You & I have talked & you know my position. The situation you described was a good one, the fact you had med control state you were doing the right thing was a bonus. I say that because you are a thinking medic. You think about your patient first, their outcomes & how you can make them better. There are those however who are more concerned with a CYA mentality,...

Yeah man, and this is my weakness I'm afraid. I tend to look at this from my limited experience as I've not worked in any of those regressive systems. Some of the medics I work with are really strong, and I'm starting to get stronger, so I rarely think in terms of mother may I. I do think, and it pains me greatly to say this, that I'm starting to see your point...

... The education content itself needs to be addressed, especially when in the chat I have heard outdated principals of the golden hour etc are still taught as gospel. How can we be taken seriously when this is the case?

Are you saying then that an increase in education will eliminate the need for med con? I think you could be right, but I wonder how many of the medics that need it would really need it had they not cut their teeth being forced to use it? I'm not so sure that in the systems addressed in this thread that it's so much an issue of intelligence and education as it is the shaping of dependence behavior? I was blessed to cut my teeth in Afg where autonomy was relatively assured so it's natural that I like to do my own thing. But I wonder, if I took my same life experience, education yet popped my cherry in California, would I have the same attitude? Not sure.

I am a firm believer in removal of med control because I do not see any overall benefit. I support Clinical assistance, either online or on phone, specifically for what you describe, but does it really need to be a doctor? My service has sucessfully introduced a referral program where a triage nurse sits on the phone & takes a Hx from a patient prior to dispatch if the person has answered specific questions in the initial call, & they are now being routinly not taking up ambulance time & resources. With the advent of PDA & smartphones, we now have unprecedented acces to publications that give us a full detail of every drug on the market, would we not be better to utilize these, with our education to make a judgement? Yes med control is foreign to me, does it make it wrong? Not really. Could EMS in the US be done better? Most definitly. Is the US alone in this? HELL NO.

I think where I went off into the ditch, again, is missing the word "need." I wasn't really making the distinction between you calling your folks for advice and me calling mine. I think it's finally sinking into my thick head that what you're talking about is being forced to conference for common issues, and yeah, I don't think I'd do well in a system like that. I'm not sure why the issue remains though that we call docs and you don't? Do you have shortage of docs in Aussie land? I mean, when I watched Crocodile Dundee there were witch doctors running around all over the place...

Anyone who is deluded enough to believe thet work for a eutopian service is publicly masterbating & should be locked up in the funny farm.

Damn it...if you'd told me that we're not supposed to masturbate publicly sooner you could have saved me a fortune in fines and counciling..

Medicine, or more correctly, All medicine is a perpetually evolving animal that we, as professionals & as a profession need to be perpetiually advancing our knowledge & skills with current practice. Med control, as dust said, is a hang over from the 70's, we have changed a lot since the 70's, so why have we not changed from a med control environment into more modern & appropriate practice?

Man, I think I get it finally. You're right I think. I don't need medical control. I do need oversight, in case I suddenly decide to do lazy, or cowboy medicine, but I don't need hand holding and the growth and entry level education of those that need their hands held is certainly being retarded by this practice. My opinion now, subject to change given new information or points of view, is that med con in the US is pathologic to the progression of intelligent, professional prehospital medicine.

You win...and I thank you.

Dwayne

[Kiwiology]

Man, I think I get it finally

Welcome to the other side mate.

Of course EMS needs strong medical input and advice from subject matter experts in a collegual relationship, quick chat about whether or not something is a good candidate for some advanced pain releif backup (e.g. ketamine) or salbutamol for hyperkalemia ain't the end of the world ... just shouldn't be ringing up on the Johnny and Roy phone for a bit of morphine or wanting to do anything tooo novel that might loose sight of the place of Ambulance Officers in the delivery of definitive care.

Did I mention Los Angeles recently?

[JakeEMTP]

.

Did I mention Los Angeles recently?

LOL! For some reason, this always makes me chuckle!

So I guess we are for the most part, all on the same page. Medical Direction is necessary to put in place the standing orders and for consult if WE deem it necessary. The fact that some systems still operate like Johnny and Roy is for lack of a better term right now, pathetic. As what seems to be the answer in almost every thread, education is the key to progressing US EMS and it's providers to more independent medicine. As long as there are 6 month wonders and 3 week basics allowed on Ambulances, we can never move forward.

[DwayneEMTP]

Holy crap....

If we all agree on this what the hell am I going to do with my spare time until the next argument?? (I mean, now that public masturbation has been disallowed.)

Dwayne