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On-line Medical Direction: A Prospective Study

Published online by Cambridge University Press:  28 June 2012

Richard C. Wuerz ,
Gregory E. Swope ,
C. James Holliman  and
Gaspar Vazquez-de Miguel
Richard C. Wuerz*
Affiliation:
Center for Emergency Medical Services, The Milton S. Hershey Medical Center, The Pennsylvania State University
Gregory E. Swope
Affiliation:
Center for Emergency Medical Services, The Milton S. Hershey Medical Center, The Pennsylvania State University
C. James Holliman
Affiliation:
Center for Emergency Medical Services, The Milton S. Hershey Medical Center, The Pennsylvania State University
Gaspar Vazquez-de Miguel
Affiliation:
Center for Emergency Medical Services, The Milton S. Hershey Medical Center, The Pennsylvania State University
*
Center for Emergency Medicine, The Milton S. Hershey Medical Center, The Pennsylvania State University, P.O. Box 850, Hershey, PA 17033USA
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Abstract

Objectives:

To determine the frequency with which physician, on-line medical direction (OLMD) [direct medical control] of prehospital care results in orders, to describe the nature of these orders, and to measure OLMD time intervals.

Methods:

Blinded, prospective study.

Setting:

A university hospital base-station resource center.

Participants:

Ten emergency physicians, 50 advanced life support providers.

Interventions:

Prehospital treatment was directed by both standing orders and OLMD physician orders. Independent observers recorded event times and the characteristics of OLMD.

Results:

Physician orders were given in 47 (19%) of the 245 study cases, and covered a variety of interventions, including many already authorized by standing orders. Mean OLMD radio time was four minutes (245 ± 216 seconds [sec]), and time from beginning of OLMD to hospital arrival averaged 12 minutes (718 ± 439 sec). Mean transport time in this system was 13 minutes.

Conclusion:

Despite detailed standing orders, OLMD results in orders for clinical interventions in 19% of cases. On-line medical direction requires about four minutes of physician time per call. This constituted about one-third of the potential field treatment time interval in this system. Thus, OLMD appears to play an important role in providing quality prehospital care.

Keywords

advanced life supportemergency medical servicesmedical commandon-line medical directionprehospital carestanding orders
Type
Original Research
Information
Prehospital and Disaster Medicine , Volume 10 , Issue 3: CJ Shanaberger Memorial Issue , September 1995 , pp. 174 - 177
Copyright
Copyright © World Association for Disaster and Emergency Medicine 1995

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Footnotes

*

Presented at the annual meeting of the Society for Academic Emergency Medicine, May 1993, San Francisco, California and the 8th World Congress on Emergency and Disaster Medicine, June 1993, Stockholm, Sweden.

References

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