If you have a BVM (Bag Valve Mask resuscitator), you should not need naloxone. The problem is inadequate respiration, not inadequate naloxonation.

- Rogue Medic

Medical Oversight According to the Handbook for EMS Medical Directors – Part II

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).[1]

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.

Really?

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.

Footnotes:

[1] Handbook for EMS Medical Directors
March 2012
International Association of Fire Chiefs (IAFC) and others.
USFA page with link for download

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Comments

  1. In those places referenced at the end of the post. They don’t have to hide bodies. They hide them in the open. In a persistent vegetative state at the local scary nursing home no one wants to go in but everyone knows is a hellhole, not even the soulless state inspector.

  2. one of the sad side affects I have seen of this is the expectations and perceived role the doctors play on the other end of the magic call. They forget that they are doctors who may be able to offer advice and insight on tricky calls or situations. Often times, at least in the wonderful city I’m in, the doc in the box wants you to do satnding orders before calling and not call before you need to enlist medical control options. If you ask for advice, they think you must not know your protocols, and will deny everything, and will most likely pull your chart for review and possibly restrict you from working while they “investigate.” It’s sad that we can’t use all the medications and tools we carry and train to use without having to call a doctor who should know we already know how to use what we carry.

  3. 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?

    None of that here in Australia. Just paramedics with a three year university education, and a clinical group (comprising of specialists and paramedics) overviewing our guidelines.
    We still have our own little problems, nothing is perfect – but we are given enough trust to be given the right tools, and use them appropriately.

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