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On-line medical command in theory and practice.

M H Erder1, S J Davidson, R A Cheney

  • 1Leonard David Institute of Health Economics, University of Pennsylvania, Philadelphia.

Annals of Emergency Medicine
|March 1, 1989
PubMed
Summary

On-line medical command (OLMC) for paramedics increased on-scene time but showed a trend toward improved patient health status. Expanding paramedic discretion in OLMC may enhance its effectiveness.

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Area of Science:

  • Emergency Medicine
  • Prehospital Care
  • Medical Command Systems

Background:

  • Paramedics frequently utilize on-line medical command (OLMC) for advanced life support (ALS) interventions.
  • Current OLMC protocols often involve broad patient inclusion and limited paramedic autonomy.
  • The efficacy of OLMC under these conditions requires thorough evaluation.

Purpose of the Study:

  • To assess the efficacy of on-line medical command (OLMC) in advanced life support (ALS) settings.
  • To evaluate the impact of OLMC on on-scene time and patient health status.
  • To explore the relationship between paramedic discretion and OLMC effectiveness.

Main Methods:

  • Retrospective analysis of advanced life support patient data.
  • Comparison of patient outcomes between those receiving OLMC and those not.
  • Documentation of physician-directed deviations from treatment protocols during OLMC calls.

Main Results:

  • OLMC use was associated with an average increase of eight minutes in on-scene time.
  • Physician-directed deviations from protocols occurred in 3.7% of OLMC calls.
  • A trend towards improved patient health status was observed with OLMC use (5.5% vs. 3.2%), though not statistically significant (P = .1).

Conclusions:

  • While OLMC increases on-scene time, it shows a potential benefit in patient health status.
  • Limited paramedic discretion and broad patient inclusion may not optimize OLMC efficacy.
  • Targeted OLMC use with expanded paramedic discretion warrants further investigation and controlled comparative studies.

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