Hostname: page-component-cd9895bd7-jn8rn Total loading time: 0 Render date: 2024-12-27T10:07:17.808Z Has data issue: false hasContentIssue false
  • English
  • Français

Comparison of Interventions in Prehospital Care by Standing Orders Versus Interventions Ordered by Direct [On-line] Medical Command

Published online by Cambridge University Press:  28 June 2012

C. James Holliman ,
Richard C. Wuerz ,
Gaspar Vazquez-de Miguel  and
Steven A. Meador
C. James Holliman*
Affiliation:
Center for Emergency Medicine, The Milton S. Hershey Medical Center, The Pennsylvania State University, Hershey, Pa.
Richard C. Wuerz
Affiliation:
Center for Emergency Medicine, The Milton S. Hershey Medical Center, The Pennsylvania State University, Hershey, Pa.
Gaspar Vazquez-de Miguel
Affiliation:
Center for Emergency Medicine, The Milton S. Hershey Medical Center, The Pennsylvania State University, Hershey, Pa.
Steven A. Meador
Affiliation:
Center for Emergency Medicine, The Milton S. Hershey Medical Center, The Pennsylvania State University, Hershey, Pa.
*
Center for Emergency Medicine, The Milton S. Hershey Medical Center, P.O. Box 850, Hershey, PA 17033USA
Get access Rights & Permissions [Opens in a new window]

Abstract

Objective:

The aim of this study was to compare the patient care measures provided by paramedics according to standing orders versus measures ordered by direct [on-line] medical command in order to determine the types and frequency of medical command orders.

Design:

Prospective identification of patient care measures done as part of a prehospital quality assurance program.

Setting:

An urban paramedic service in the northeast United States with direct medical command from three local hospitals.

Participants:

One thousand eight paramedic reports from October 1992 through March 1993.

Interventions:

All patient care interventions recorded as done by standing orders or by direct medical command orders. Errors in patient care were determined by the same criteria as in the prior two studies of the same system.

Results:

Direct medical command gave orders in 143/1,008 (14.2%) cases. Paramedics performed 2,453/2,624 (93.5%) of the total patient care interventions using standing orders. In 61 cases (6.1 %), medical command ordered a potentially beneficial intervention not specified by standing orders or not done by the paramedic. 21/171 (12.3%) command orders were for additional doses of epinephrine or atropine in cardiac arrest cases (where the initial doses had been given under standing orders), and 59/171 (34.5%) were for interventions already mandated or permitted by standing orders. The paramedic error rate was 0.6%, and the medical command error rate was 1.8% (unchanged form the prior study of the same standing-orders system).

Conclusion:

Direct medical command gave orders in 14% of cases in this standing-orders system, but 35% of command orders only reiterated the standing orders. More selective and reduced uses of on-line command could be done in this system with no change in the types or numbers of patient care interventions performed.

Keywords

emergency medical servicesmedical commandmedical controlon-line medical commandparamedicsprehospital carestanding orders
Type
Original Research
Information
Prehospital and Disaster Medicine , Volume 9 , Issue 4 , December 1994 , pp. 202 - 209
Copyright
Copyright © World Association for Disaster and Emergency Medicine 1994

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1. Erder, MH, Davidson, SJ, Cheney, RA: On-line medical command in theory and practice. Ann Emerg Med 1989;18:261–268.Google Scholar
2. Wasserberger, J, Ordog, GJ, Donoghue, G, et al. : Base station prehospital care: judgment errors and deviations from protocol. Ann Emerg Med 1987;19:867–871.CrossRefGoogle Scholar
3. Hedges, JF, Heiser, JM, Neely, KW, et al. : Analysis of base station morphine orders: Assessment of supervising physician consistency. J Emerg Med 1990;8:587–590.Google Scholar
4. Pointer, JE, Osur, MA: Effect of standing orders on field times. Ann Emerg Med 1989;18:1119–1121.CrossRefGoogle ScholarPubMed
5. Tortella, BJ, Lavery, FR, Gody, RP, et al. : Standing orders for field intravenous lines do not shorten prehospital time in trauma patients, Prehospilal and Disaster Medicine 1992;7:271–276.Google Scholar
6. Ornato, JP, Groen, AL: Superiority of standing orders to start an IV during cardiac arrest over base station orders. Nebraska Med J 1985;70:200–201.Google Scholar
7. Cayten, CG, Oler, J, Walker, K, et al. : The effect of telemetry on urban prehospital cardiac care. Ann Emerg Med 1985;14:976–981.Google Scholar
8. Pozen, MW, D'Agonstino, RB, Sytkowski, PA, et al. : Effectiveness of prehospital medical control systems: An analysis of the interaction between emergency room physicians and paramedics. Circulation 1981;63:442–447.Google Scholar
9.Champion, HR, Sacco, WJ, Gainer, PS, et al. : The effect of medical direction on trauma triage. J Trauma 1989;28:235–259.Google Scholar
10. Neely, KW, Norton, R, Butkus, E, et al. : The effect of base station contact on ambulance destination. Ann Emerg Med 1990;19:906–909.CrossRefGoogle ScholarPubMed
11. Pointer, JE, Osur, M, Campbell, C, et al. : The impact of standing orders on medication and skill selection, paramedic assessment, and hospital outcome: A follow-up report. Prehospital and Disaster Medicine 1991;6:303–308.CrossRefGoogle Scholar
12. Holliman, CJ, Wuerz, RC, Meador, SA: Medical command errors in an urban advanced life support system. Ann Emerg Med 1992;21:347–350.CrossRefGoogle Scholar
13. Holliman, CJ, Wuerz, RC, Meador, SA: Decrease in medical command orders with use of a standing-orders protocol system. Am J Emerg Med 1994;12:279–283.CrossRefGoogle ScholarPubMed
14. Palafox, J, Pointer, JE, Marchenke, J, et al. : The 1989 Loma Prieta earthquake: Issues in medical control. Prehospital and Disaster Medicine 1993;8:291–297.CrossRefGoogle ScholarPubMed
15. Holliman, CJ, Swope, G, Mauger, L, et al. : Comparison of two systems for quality assurance of prehospital advanced life support services. Prehospital and Disaster Medicine 1993;8:303–310.CrossRefGoogle ScholarPubMed
16. Wuerz, RC, Holliman, CJ, Vazquez-de Miguel, G: On-line medical direction: A prospective study. Ann Emerg Med 1993;22:918.Google Scholar