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

- Rogue Medic

Being Fooled By Appearances

In EMS, we are sometimes quick to draw conclusions about what we are dealing with. This is not entirely our fault. Medical directors have frequently required that we get all of that assessment stuff out of the way quickly, so that we can call on line medical command to go through the Mother May I? routine.

Is this any way to encourage a thorough assessment?

Of course not.

We frequently end up making this call in front of the patient, so we have to balance making statements that may upset the patient with upsetting the doctor by presenting a vague, or incomplete, picture.

A recipe for failure?


Quick impressions are often wrong, or overly simplistic, but that is what the people behind on line medical command permission requirements insist on.

Image credit.

I find it amusing that a mortgage company is using these commercials that point out the ways that we can leap to completely wrong conclusions.


And since it is the day when a lot of people defile weak beer with green food dye, an optical illusion of a four-leaf clover is appropriate.

Image credit.

Why do national celebration days end up as drinking holidays, rather than demonstrations of the qualities of the nationalities?

though I am native here
And to the manner born, it is a custom
More honor’d in the breach than the observance,

Hamlet Act 1, scene 4,
explanatory notes from eNotes.com

The on line medical command Mother May I? recklessness and the drunken revelry as national pride are both pathetic.

These are traditions that are dishonorable when not broken.

Don’t get in trouble for not calling command when it is required, but feel free to point out the foolishness of this practice. There is no evidence of any benefit from on line medical command Mother May I? requirements. These requirements only encourage medical directors to authorize dangerous medics to work as medics.

A magic phone call does not transform a dangerous medic into a safe medic.

On line medical command permission requirements only provide the appearance of oversight, but without any of the substance of oversight. We need to stop pretending that medical directors are doing anything other than fooling themselves with appearances.



  1. I couldn’t agree with you more. Here in the mountains, we have luckily come a long way. When I first started working here, it was common practice to call the local hospital where our medical control was for every transport. I mean every single transport. It didn’t matter that 99% of the patients were being transport to a different facility. On top of this was the fact that the medics weren’t talking to an MD to get orders, it was just a nurse. I questioned this practice from day one and always received the same answer, We’ve always done it this way. Now, thank God, we’ve put that archaic practice out. Plus, in the majority of every protocol, contacting medical control is at the bottom of the list. Nice blog by the way.

  2. Have I told you lately that I love you?! Please move to Florida! We need you and your street level expertise here. It’s wonderful to read article after article of ‘common sense” approaches to modern day emergency medicine!

  3. I agree completely! Although it is important and beneficial to have the option of calling medical control when we need help, we should not have to calll and ask for permission to treat the patient using the medications and therapies available to us. If we are to be trusted to properly implement and manage a certain treatment while the patient is in our care, then we must have the knowledge and assessment skills to determine if it is appropriate for the situation.

    And conversely, if a person is too incompetent to know when and how to use a certain medication or treatment, should they be allowed to use it under any circumstances? I don’t think so.

    • Exactly. I would be ashamed to call myself a Medical Director if I didn’t have the knowledge and confidence in myself to teach and supervise my Paramedics to use every drug and technique available in 2012. Get off your butt and teach your staff or get out of the business!

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