On-line medical command in theory and practice

• Published in: Annals of emergency medicine Vol. 18; no. 3; pp. 261 - 268
• Main Authors: Erder, M Haim, Davidson, Steven J, Cheney, Rose A
• Format: Journal Article
• Language: English
• Published: New York, NY Mosby, Inc 01.03.1989; Elsevier
• Subjects: Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Biological and medical sciences; Efficiency; Emergency and intensive care: techniques, logistics; Emergency Medical Service Communication Systems; Emergency Medical Services - organization & administration; Emergency Medical Technicians; Evaluation Studies as Topic; First Aid; Heart Diseases - therapy; Humans; Intensive care medicine; Life Support Systems; Medical sciences; Miscellaneous; on-line medical command; Online Systems - organization & administration; Outcome and Process Assessment (Health Care); Philadelphia; Wounds and Injuries - therapy; Philadelphia; on-line medical command; Cardiovascular disease; Telecommunication; Prehospital period; Emergency; Trauma; Resuscitation
• ISSN: 0196-0644; 1097-6760
• DOI: 10.1016/S0196-0644(89)80411-1

Paramedics are often required to use on-line medical command (OLMC) when they provide advanced life support. We evaluated the efficacy of OLMC use under this broad patient inclusion rule and limited paramedic discretion. OLMC was associated with an average of an eight-minute longer on-scene time, and an infrequent rate of physician-directed deviation from written treatment protocols (3.7% of all OLMC calls). Of the system's advanced life support patients, 6.1% experienced changes in their prehospital health status, reflected in changes in the patient's level of consciousness. OLMC use was associated with improved health status in 5.5% of patients compared with 3.2% for those treated without OLMC ( P = .1). The health status of 1.3% of the patients treated with OLMC deteriorated. This was not significantly different from the 1.1% of patients treated without OLMC whose status deteriorated. We suggest that targeted OLMC use with expanded paramedic discretion may improve the efficacy of OLMC. Further controlled comparative studies of OLMC efficacy under targeted OLMC use versus broad patient inclusion rules are needed.