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Medical Control of Mass Gatherings: Can Paramedics Perform Without Physicians On-site?

Published online by Cambridge University Press:  28 June 2012

Cary C. McDonald ,
Max D. Koenigsberg  and
Sharon Ward
Cary C. McDonald
Affiliation:
University of Illinois College of Medicine, Emergency Services, University of Illinois Hospital, Chicago, Ill. Department of Emergency Services, Wake Medical Center, Raleigh, N.C.
Max D. Koenigsberg*
Affiliation:
University of Illinois College of Medicine, Emergency Services, University of Illinois Hospital, Chicago, Ill. Illinois Masonic Medical Center, Emergency Medical Services, Chicago, Ill.
Sharon Ward
Affiliation:
Illinois Masonic Medical Center, Emergency Medical Services, Chicago, Ill.
*
Illinois Masonic Medical Center - EMS, 836 West Wellington Ave., Chicago, IL 60657USA
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Abstract

Objective:

Evaluate the experience of paramedic personnel at mass gatherings in the absence of on-site physicians.

Design:

Retrospective review of patients evaluated by paramedics with emergency medical services (EMS) medical control.

Setting:

First-aid facility operated by paramedics at an outdoor amphitheater involving 32 (predominantly rock music) concerts in accordance with the Chicago EMS System, June through September 1990.

Participants:

A total of 438 patients (≤0.1% on-site population) were evaluated.

Interventions:

Presentations to the first-aid facility were viewed as if the patient was presenting to an ambulance. Transportation to an emergency department was strongly recommended for all encounters. Time from presentation to the first-aid facility until disposition was limited to 30 minutes in the absence of on-line [direct] medical control. Refusal of care was accepted. On-line [direct] medical control with the EMS resource hospital was initiated as needed. Off-line [indirect] medical control consisted of weekly reviews of all patient records and periodic site visits.

Results:

Of the 438 patients, 366 (84%) refused further care, including 31 patients (7%) who refused advanced life support (ALS) level care. Seventy-two patients (16%) were transported; 37 by ALS and 35 by basic life support (BLS) units. On-line [direct] medical control was initiated in all ALS patients that were transported as well as for those who refused care. No known deaths or adverse outcomes occurred, based on lack of inquiries or complaints from the local EMS system, emergency departments receiving transported patients, law enforcement agencies, 9-1-1 emergency response providers, venue management, or security. No request for medical records from law firms have occurred. Problems noted initially were poor documentation and a tendency not to document all encounters (e.g., dispensing band-aids, tampons, earplugs, etc.). Concerns noted included: initial and subsequent vital signs, times of arrival, interventions, dispositions, and patient conditions of refusal. Specific problems with documentation of refusals at disposition included: appropriate mental status, speech, and gait; release with an accompanying family member or friend; and parental notification and approval of care for minors. There also was an initial tendency not to establish on-line [direct] medical control for ALS refusal or BLS medicolegal issues.

Conclusions:

The medical system configuration modeled after practices of prehospital care, demonstrates physicians did not need to be onsite when adequate EMS medical control existed with less than 30 minutes on-scene time.

Keywords

ambulanceconcertsdispositionemergency departmentemergency medical servicesfirst-aidmass gatheringmedical controlmedical coverageparamedicspatientquality assurancerefusal of careresource hospital
Type
Original Research
Information
Prehospital and Disaster Medicine , Volume 8 , Issue 4 , December 1993 , pp. 327 - 331
Copyright
Copyright © World Association for Disaster and Emergency Medicine 1993

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