Medical Command-an oldie but goodie

[resqmdc14]

Scenario:

Medical command we're en-route to XYZ ER with a cardiac patient requesting the following orders. Orders denied just transport.

ER physician wants your a#$ because no treatment killed the guy and wants to know why he wasn't involved in the decision process.

Our medical command facility is 2 hours away. We radio or phone them with report, they relay it on and we still call in to the receiving facility. Back when I first started medical command was the receiving facility, because that doc was going to see the patient. Don't get me wrong, I like the MCP concept, but don't you think the receiving doc should have a say in what is going on.

Here's me personal favorite: I can't go on scene and have my dispatch send me a helicopter that is within the boundaries of my home county(no more than 10 minutes away from me) or I get a write up from my medical command center. I have to radio my info to MCP, request my chopper, then hope they send the one I want and not make me wait for someone else.

I'm on scene. I know what I need. I can just add in to my radio report that I flew the patient out. Our command says they need to be "in the loop" because they have to track aeromedical traffic. What are they a control tower or the FAA? :roll:

Anyone care to let me know how well or how bad their system works? Let me know. I'd love to have some ideas to take to our next Critical Care Committee meeting to see if we can smooth things out. E mails on this matter are also welcome:

resqmdc14@yahoo.com.

[nsmedic393]

I'm lucky, there are precious few scenarios that require me to call a doctor. There are absolutely no scenarios where a on-line docs decision would compromise my patient care.

We have MCPs from all over the province on duty. Its a pretty rare occurance when the on-line doc is also the recieving doc, however its also a rare occurance that I even call the MCP.

Here is a copy of the policie.

Mandatory Physician Contact Policie

[jjcapo]

I have a hard time understanding why you can't get command from the facility that you are transporting to. Did I misread?? Maybe somebody can explain that one to me. I am lucky that it is very rare that we need command, our protocols are very aggressive. Be safe and have a great day.

[resqmdc14]

We went to a statewide protocol a few years back. One of the changes included in this placed medical command in certain areas and the radio systems throughout the state upgraded to accomidate it. One center covers most of the northern part of the state and one other center the southern part. I like the idea of having docs that are up on our protocols to help assure an equal standard of care, but I also think that the receiving doc should be in on the desision process since they are the ones seeing the patients. I do have to admit that things have gotten better in the past few years with the changes that were made, but I really think that the system as a whole needed a little more thought process. For instance, our MCP is on one set frequency, however, the area i run in only has one out of 5 facilities that we go to that also utilizes that same frequency. The others are all on another channel, so the receiving facility doesn't hear what's coming until MCP center calls and tells them, unless we do a second report just to let them know we're coming.

[Spock]

I feel your pain. We have destination command unless we want to give a controlled drug (morphine, fentanyl, versed, valium) then we have to call our command hospital and they relay the information to the receiving hospital if it is different. We also have to call command in order to get a helicopter because we have some idiots in the system that have flown people for nose bleeds! The medic on that one swore she felt a pulsating abdominal mass. A classic example of dumbing down the system because of the lunacy of a few. Luckily she is no longer a medic.

Some people get around the problem by having the fire chief or police officer request a helicopter. We have so many birds in this area that they wouldn't turn down a flight no matter how inappropriate. Command knows this happens but turns a deaf ear to it. Some system isn't it! Many of our docs don't even know our protocols. We routinely get orders for ativan when we don't have it in the drug box.

Live long and prosper.

Spock