The Handbook for EMS Medical Directors was developed by the International Association of Fire Chiefs (IAFC) as part of a Cooperative Agreement with the Department of Homeland Security (DHS), Federal Emergency Management Agency (FEMA), U.S. Fire Administration (USFA), and was supported by DHS, Office of Health Affairs (OHA).
The magic phone call suggests that only these magic phone call treatments are the potentially dangerous treatments, while other treatments are safe, or comparatively much safer.
There is no basis for claiming that the treatments that require medical command permission are any more dangerous than treatments that do not require the magic phone call. So, what is the basis for this kind of requirement?
Why do some places require medical command permission for a lot of treatments, while others do not require medical command permission for anything?
Do they treat patients who are that different?
Do they use fewer treatments?
Do they not know the incantation to make the magic phone call work?
Do the medical directors just not like being called Mother on these Mother-May-I? calls?
Or do they just have medical directors who provide valid medical oversight?
If the most progressive medical directors have the least use for medical command permission phone calls, what does that say about the value of the medical command permission phone call?
Back in the good ol’ days, we had to use the magic phone call before we did anything.
For permission to transport to the hospital.
For permission to start an IV.
For permission to defibrillate.
For permission to give any medication.
In some places, the medication orders were given by the color of the box of medication. Different manufacturers use different colors, so a change in manufacturer would change the medication delivered. Is that competent medical oversight?
The requirements for medical command permission have almost always moved in one direction –
fewer requirements to make the magic phone call more standing orders.
The result has not been a cover-up of medical mass murder.
What if we called some of the medical command doctors for orders to treat severe pain?
There have been very rare benefits, such as the Maryland requirement to call for medical command permission to call for a helicopter for patients with Mechanism Of Injury. Why fly a patient with a Mechanism Of Injury, rather than assess the patient for an actual injury?
The basis for the Mechanism Of Injury criteria for flight is the expectation that EMS is incompetent.
Or was this just an antidote to the medical directors who wanted every occupant of every car with a dented bumper flown?
The basis for the medical command permission phone call is the expectation that EMS is incompetent.
The result of the medical command permission phone call is the ability to feel that EMS incompetence does not matter, because They have to call to do anything dangerous.
Sign here. That’s probably just indigestion.
Fever, tachycardia, and crackles all over – some Lasix will make the crackles all better.
In the places that do not have medical command phone call requirements, are they incompetent at medical care, but just very competent at hiding the dead bodies?
See also –
The Permisson Paradox by Bob Sullivan.
Adios, Rampart – Give medical control the boot by Dr. Bryan Bledsoe.