Without evidence of benefit, an intervention should not be presumed to be beneficial or safe.

- Rogue Medic

OLMC = The Used Car Dealers of EMS?

In your last post, we were talking about the dangerous medic – Medic X; you called the medical directors who create OLMC (On Line Medical Command) requirements the used car dealers of EMS. What did you mean?

They are selling you an idea, but they are not delivering any substance.

What is the idea?

OLMC barriers to patient care protect patients.

Do OLMC barriers to patient care protect patients?

To protect patients you have to keep Medic X away from the patients – he’s dangerous!

Does OLMC keep Medic X away from patients?

Not a chance. Without OLMC requirements the medical director would be afraid to let Medic X near any patient.

OK, OLMC doesn’t keep Medic X away from patients, but at least OLMC keeps Medic X from harming patients.

How does OLMC do that?

Well, Medic X has to call for permission to do anything dangerous.

No. Medic X only has to call for things that the protocols say are dangerous – not at all the same thing.

OLMC still has to depend on Medic X‘s assessment of the patient to decide what treatments are appropriate (or dangerous).

OLMC can coach Medic X through the assessment.

If this is a true emergency that requires prompt action from a competent medic, how does this phone call convert Medic X into the competent medic the patient needs?

The partner could help. What about Medic X‘s partner?

What if Medic X‘s partner is a basic EMT? Is OLMC going to have a basic EMT deliver care that OLMC does not trust a medic to deliver? What if Medic X‘s partner is as bad a medic as Medic X?

There doesn’t seem to be a good reason for Medic X to be working as a medic.

Now you’re getting it. The reason medical directors keep inflicting Medic X-types on the sick and injured is that they have deluded themselves into believing that OLMC barriers to patient care make it safe to let dangerous people play medic.

You think there are better ways of providing medical oversight?

What could be worse than OLMC requirements?


That might be worse, there is not any real accountability with either method.

If you have to call OLMC before you provide a dangerous treatment, that’s good. Right?

Only if it leads to better patient care.

Does OLMC lead to better patient care?

No. It leads to Medic X.

Then the medical director should get rid of Medic X.

The whole purpose of OLMC barriers to treatment is to allow for a lot of Medic X-types.

That’s doesn’t make any sense.

The OLMC barriers to patient care are supposed to protect the patient from Medic X, but really only allow the medical directors to claim that Medic X cannot do too much damage without calling OLMC.

Dizzyingly circular logic.

Why hire only good medics, when you can hire almost-good-enough people and minimize staffing problems?

So, there are a lot out there like Medic X?

Nobody knows how many.

Why do all of the medical directors do this?
It isn’t all of the medical directors, just the ones who think that they can prevent incompetence by using OLMC barriers to patient care.

What other methods of quality control are there?

That will be a topic for another post, or three.

My other posts on OLMC requirements and Medic X are:

OLMC (On Line Medical Command) Requirements Delenda Est

OLMC for President!

OLMC For Good Medics

Fun with explosives – NTG.


  1. […] requiring OLMC (On Line Medical Command) permission to treat patients does not work and actually lowers the quality of medic in a system. You state that Medic X, the example of the dangerous medic, is made worse by OLMC requirements. […]