Transcript Hennepin County EMS system

Hennepin County
EMS system
Physician Medical Control
Training Program
Instructions:
This training program has a run time of approximately 26 minutes.
Each slide will progress via automated timers. In the bottom left
corner of each slide are a Back and Forward slide control button that
can be used to move between slides manually.
If you manually go back to review a previously seen slide or a slide
you missed using the Back button you will need to manually forward
the slideshow using the Forward button.
Disclaimer
The Physician Medical Control Training Program is intended for use
only in the Hennepin County EMS system as an orientation tool to
familiarize physicians, working at an authorized system medical
control hospital, with the process of providing medical control to
paramedics in the field.
What topics will be covered by this training:
• Importance of medical control
• Foundation for medical control
• Medical control structure overview
• Liability related to medical control
• Medical control process
• 800 MHZ EMS radio operation
• Medical control certification process
• Examples of medical control calls/recordings
• Frequently Asked Questions (FAQ)
Why Medical Control Exists
Medical Control plays a valuable role in the Hennepin County EMS
system. While paramedics operate predominantly under standing
orders to treat and care for patients occasionally they may
encounter a specific patient condition, anomaly, or situation where
consultation with a physician for guidance can help the paramedics
decide the most appropriate course of action for treatment and
transport.
The Importance of Medical Control
Medical Control allows for specific drugs and/or procedures, not
authorized via standing orders but available through the ALS
medical protocols, to be administered by paramedics after
consultation with a medical control physician.
Foundation for Medical Control
The foundation for the Hennepin County EMS system is Ordinance 9.
The ordinance creates the EMS Council which develops policies and
guidelines for the EMS system. These policies and guidelines contain
reference to medical control.
Ordinance 9, Section III, Subsection 8, part C
EMS System - Ambulance Services
The Hennepin County EMS
system is comprised of five
ambulance services operating
a Primary Service Area (PSA)
within the County. They are:
• Allina Medical Transportation
• Edina Fire Department
• Hennepin EMS
• North Memorial Ambulance
• Ridgeview Ambulance
EMS System Medical Control Hospitals
Over a dozen medical control hospitals provide the backbone for the
medical control system within Hennepin County. These hospitals
employ Emergency Department (ED) physicians who have been
certified through the Health Authority to provide medical control.
Hennepin County Medical Control Hospitals
The Hennepin County system medical control hospitals are:
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Abbott Northwestern
Children’s Hospital of Minneapolis
Fairview Southdale Hospital
Hennepin County Medical Center
Maple Grove Hospital
Mercy Hospital
Methodist Hospital
North Memorial Medical Center
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Ridgeview Medical Center
St. Francis Medical Center
Two-Twelve Medical Center
Unity Hospital
University of Minnesota Medical Center
• University campus
• Riverside campus
• Amplatz Children’s Hospital
ALS Medical Protocols
The EMS Council approves the Advanced Life Support (ALS) medical
protocols which provide uniform guidance and direction to the 500 +
paramedics operating in Hennepin County.
The ALS medical protocols are continually
revised and published every two years with
input from paramedics, nurses, physicians,
hospital administrators and ambulance
medical directors.
Medical Control Process – How it Works
Medical Control may be obtained one of two ways, via radio or
phone. Depending on the communication process that each
ambulance service uses you should be ready to provide medical
control over the phone or via your hospital’s 800 MHz EMS radio.
Medical Control Process – How it Works – cont.
Some ambulance services may use a intermediary such as the
Medical Resource Control Center (MRCC) or their own
communications center to notify your ED that a physician is needed
to provided medical control.
Liability
Question – Once certified to provide medical control in Hennepin
County can I be held liable for the medical direction I provide when I
give medical control to paramedics?
Answer – Yes. All medical control calls are recorded and retained
for one year. These records are discoverable if legal action should
ensue related to the incident.
800 MHz EMS Radio
Push-to-Talk
• Button on inside of
handset
•Press to talk – Wait
for talk permit tones
(beep-beep-beep)
• Release and wait if
you hear a busy tone
(b-o-n-k)
• Release to listen
• Simple Operation –
only one person
speaking at a time
Volume Knob
Controls the loudness
of the received signal
Push-to-Talk
• Press red button to
talk – Wait for talk
permit tones (beepbeep-beep)
• Release and wait if
you hear a busy tone
(b-o-n-k)
• Release to listen
• Simple Operation –
only one person
speaking at a time
Medical Control Certification Process
Physicians new to the Hennepin County Medical control system must
undergo a certification process. The process includes:
• Completion of this training program
• Completion of the certification exam
Medical Control Certification Process – cont.
Upon completion (with a passing score) of the exam and required
paperwork you will be issued a medical control certification number.
This number is assigned to you and is unique within the system.
Medical control physicians shall provide their certification number to
paramedics who contact their hospital requesting medical control.
Medical Control Certification Process – cont.
Specific details about your Medical Control certification number:
Do not lend your number to another physician for use. This number
is unique to you and is recorded on the paramedic’s Patient Care
Report (PCR) to identify you as the physician who provided medical
control.
Audio Recordings of Medical Control
In the following slides you will hear three examples of medical
control conducted over the 800 MHz radio system. On the slides
there will be embedded media that appears as a black box. The
media will launch automatically and you will hear the audio for the
medical control call. While there is no accompanying video with the
audio, please pay attention to the media box for teaching points that
will intermittently pop up at points throughout the audio recording.
Audio Recording of Medical Control
Example #1 – Adult Diabetic Emergency
This recording represents an example of a medical control call for an
adult diabetic patient who has received treatment but does not wish
to be transported to the hospital via ambulance.
Recording will launch automatically.
Audio Recording of Medical Control
Summary of Example #1 – Adult Diabetic Emergency
What went right:
• The physician provided his medical control certification number.
• The physician asked
pertinent questions.
What went wrong:
• A complete set of vital signs were not provided or asked for.
Audio Recording of Medical Control
Example #2 – Adult Hypotension
This recording represents an example of a medical control call for an
adult patient with end-stage cancer, difficulty breathing, and
hypotension.
Recording will launch automatically.
Audio Recording of Medical Control
Summary of Example #2 – Adult Hypotension
What went right:
• The physician provided his medical control certification number.
• The physicians asked pertinent questions.
• The physician quickly recognized that the patient was very ill.
• The physician quickly ascertained that, due to the gravity of the patient’s
condition, a diversion to a closer hospital was necessary.
What went wrong:
• The time it took for the physician to respond to the request for medical
control was long (actual recording this example was based on was over a two
minute wait).
Audio Recording of Medical Control
Example #3 – Adult Homicide
This recording represents an example of a medical control call for an
adult patient in traumatic cardiac arrest secondary to being stabbed.
Recording will launch automatically.
Audio Recording of Medical Control
Summary of Example #2 – Adult Homicide
What went right:
• The physician provided his medical control certification number.
What went wrong:
• The physician failed to recognize that the paramedics were unsure what they should
do with this patient.
• Although the paramedics clearly stated at the onset of the call that the patient was in
Asystole, four minutes into the conversation no decision had yet been made to
resuscitate the patient or not.
• The physician fixated on the specifics of the knife.
• Inappropriate comments were made by the physician.
Frequently Asked Questions (FAQ)
Q. Does my Hennepin County medical control certification number
have any applicability or relevance outside the Hennepin County
EMS system?
A. No. Your system medical control certification number is relevant
only within the Hennepin County EMS system.
Frequently Asked Questions (FAQ)
Q. If I stop and/or render aid at the scene of an emergency in
Hennepin County are there any system policies or guidelines that
define my authority?
A. Yes. Please see the Hennepin County ALS Protocols, General
Guidelines: Physician Presence at the Scene of an Emergency
guideline.
Frequently Asked Questions (FAQ)
Q. Should I give my medical control number to the paramedic on the
phone/radio?
A. Yes. If you do not provide this information when you initially
answer the call you should provide it sometime before the end of
the transmission. It is your responsibility to include your medical
control number in the recording that is being made, even if the
paramedic does not specifically ask for it.
Frequently Asked Questions (FAQ)
Q. If I am issued a physician medical control number, then leave the
system medical control hospital I am certified at for employment
at another system medical control hospital, do I continue to use
the same certification number?
A. No. You will be issued a new certification number that coincides
with the assigned number series for the new hospital where you
will be working. If you are employed at more than one hospital
you will be assigned a number for the hospital where you work
most of your hours.
Frequently Asked Questions (FAQ)
Q. I have completed this training program, what should I do now?
A. After completion of this training program you should obtain the
necessary paperwork from the Health Authority EMS Unit’s
website to self-administer the physician medical control exam.
Frequently Asked Questions (FAQ)
Q. I completed the exam and faxed it in to the Health Authority,
what now?
A. Your exam will be graded and you should be contacted by staff
from the Health Authority with your results. If you have passed
the exam you will be assigned a medical control number.
Frequently Asked Questions (FAQ)
Q. I passed the exam and received my medical control certification number,
is there anything else I need to do?
A. The final step in your certification process is to do a radio check with the
West MRCC over your hospital ED’s 800 MHz EMS radio.
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Call the West MRCC at 612-347-2123
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Tell them you are a newly certified medical control physician and
would like to do a radio check.
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The West MRCC Dispatcher will direct you to your radio and ask
you to press the Push-To-Talk (PTT) button to do your radio
check. Press and hold the PTT button and state “this is <your
medical control certification number> doing a radio check for
<your hospital’s name>.
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The WMRCC dispatcher will confirm receipt of your transmission.
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You have now completed your certification process.
Contact Information
If you have any medical control related questions, please contact:
Question related to the examination process:
Hennepin County Human Services and Public Health Department
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Phone (612) 348-6001
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Fax (612) 348-3830
Question related to medical control:
Hennepin County Human Services and Public Health Department
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Phone (612) 348-5423
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Fax (612) 348-3830