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

- Rogue Medic

Call Audit in Contra Costa

In California, at least at the time this took place, OLMC (On Line Medical Command) was something that only a few hospitals provided. When it started, it was believed that they could direct paying patients to their facilities, so a bunch of hospitals were providing OLMC. At least that was the rumor. After a while the reality of the expense and the lack of the expected financial triage effect caused some to give up providing OLMC.

A Call Audit (or Tape Audit) is a California term for a review of OLMC contacts on a recorded line. It can be positive, negative, neutral, or just focus on a specific medical condition.

The most memorable one I attended was in Contra Costa County, right next door to Alameda County. Alameda County was a somewhat progressive county in California EMS (probably still is). Contra Costa would probably punish you if you used the word progress in a sentence.

The purpose of the Call Audit was to inform people of a change in protocol. The Chest Pain protocol would no longer require OLMC permission prior to starting an IV.


What year was this?

A. 1973?

B. 1983?

C. 1993?

D. 2003?

E. 2013?

Their explanation for this radical departure from sanity – actually trusting medics to start an IV on a patient with active chest pain without the recorded permission of OLMC?

First, a bit about OLMC in California (at least back then). MICNs (Mobile Intensive Care Nurses) are nurses trained to provide OLMC to the medics. The M (Mobile) is not referring to them, since they are in a radio room. The I (Intensive) does not have to do with much more than providing a vowel in the unpronounceable acronym. Not that they aren’t good nurses, but why the overly fancy title for someone to recite the OLMC-only parts of protocol to the medics?

Contra Costa was shutting down one of two OLMC facilities. The math here is not especially difficult. The remaining OLMC facility received almost double the number of OLMC calls it received when there were two OLMC facilities. If I recall correctly, the less busy facility was the one that closed.

At the Call Audit, the OLMC representative tried to put a positive spin on the development.

“We are trusting you to make this important decision. Don’t abuse it!”

They are receiving twice as many calls as they used to. Their nurses are having trouble keeping up with the volume of calls. The county EMS people decide that it is better to recognize reality and allow medics to start IVs on cardiac patients without calling for permission first.

They present this protocol change to the medics as being a tentative move to improve trust if the medics demonstrate appropriate restraint when given this huge responsibility.

When people lie, it does not encourage you to trust them.

Every medic knew that there was no way this protocol would be rescinded. The previous protocol, because of the volume of calls, was dead. Why do these administrators think medics are dumb?

Just another example of idiots micromanaging things they do not understand and making things worse (not by this change, but by resisting this appropriate change for so long).

Oh, the year was 1993. They were still practicing “Johnny and Roy call for permission for everything” EMS almost 2 decades later.

Other OLMC posts:

OLMC (On Line Medical Command) Requirements Delenda Est

OLMC for President!

OLMC = The Used Car Dealers of EMS?

OLMC For Good Medics

Fun with explosives – NTG.

Failure to communicate