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The Impact of Standing Orders on Medication and Skill Selection, Paramedic Assessment, and Hospital Outcome: A Follow-up Report

Published online by Cambridge University Press:  28 June 2012

James E. Pointer ,
Michael Osur ,
Colleen Campbell ,
Ben H. Mathews  and
Chet McCall
James E. Pointer*
Affiliation:
Medical Director, Emergency Medical Services Agency, City and County of San Francisco, California. Formerly Medical Director for Alameda County EMS District, Oakland, California
Michael Osur
Affiliation:
Prehospital Care Coordinator, Alameda County EMS District, Oakland, California
Colleen Campbell
Affiliation:
Research Associate, Alameda County EMS District, Oakland, California
Ben H. Mathews
Affiliation:
Director, Alameda County EMS District, Oakland, California
Chet McCall
Affiliation:
Professor of Research Methods, Pepperdine University, Culver City, California
*
Emergency Medical Services Agency, 135 Polk Street, 2nd Floor, San Francisco, CA 94102, USA, (415) 554-2920, Fax (415) 554-2921
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Abstract

Introduction:

A prior report demonstrated a five-minute decrement in scene and total prehospital times in the standing order and limited standing order intervals as compared to control.

Methods:

The Alameda County Emergency Medical Service (EMS) District studied the impact of standing orders on field times, comparison of paramedic assessments with emergency department diagnoses, field drug use and procedures, and hospital outcome. These variables were studied over three discrete, six-week, time-study intervals, which represented three different levels of base-hospital medical control (control, standing order, and limited standing order).

Results:

There were no statistically significant differences between the three time-study intervals for the following variables: 1) incidence of prehospital administration of three cardiac arrest drugs; 2) incidence of prehospital administration of no drugs; 3) incidence of performance of endotracheal intubation; 4) incidence of performance of defibrillation; 5) assessment comparison; and 6) hospital outcome. There were statistically significant differences between intervals for incidence of: 1) administration of naloxone; 2) administration of 50% dextrose; 3) intravenous (IV) starts; and 4) paramedic performance of no procedures.

Conclusion:

Although there are several potential flaws in method, the data suggest that standing orders result in decreased incidence of drug administration and IV starts in non-critical situations without a negative impact on paramedic assessments or hospital outcome.

Type
Original Research
Information
Prehospital and Disaster Medicine , Volume 6 , Issue 3 , September 1991 , pp. 303 - 308
Copyright
Copyright © World Association for Disaster and Emergency Medicine 1991

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Footnotes

Presented at the Fifth Annual Conference, National Association of EMS Physicians, San Francisco, Calif. on June 8, 1989.

References

1. Pointer, JE, Osur, MA: Effect of standing orders on field times. Ann Emerg Med 1989;18:1119–1121.CrossRefGoogle ScholarPubMed
2. Pointer, JE: The emergency physician and medical control in advanced life support. J Emerg Med 1985;3:31–35.CrossRefGoogle ScholarPubMed
3. Pointer, JE: The advanced life support base hospital audit for medical control in an emergency medical services system. Ann Emerg Med 1987;16:557–560.CrossRefGoogle Scholar
4. Hoffman, JR, Luo, J, Schriger, , Silver, L: Does paramedic-base hospital contact result in beneficial deviations from standard prehospital protocols? West J Med 1990;153:283.Google ScholarPubMed
5. California Code of Regulations. Title 22 Social Security; Division 9. Prehospital Emergency Medical Services; Chapter 4. Emergency Medical Technician-P; Article 2. General Provisions, Paragraph 100144. Sacramento, 1989.Google Scholar
6. California Code of Regulations. Title 22 Social Security; Division 9. Prehospital Emergency Medical Services; Chapter 4. Emergency Medical Technician-P; Article 2. General Provisions, Paragraph 100144. 45-Day Public Comment Draft, Sacramento, CA December 21, 1990.Google Scholar
7. Hunt, RC, Buss, RR, Graham, RG, et al. : Standing orders vs voice control. J Emerg Med Serv 1982;7:26.Google Scholar
8. Wasserberger, J, Ordog, GJ, Donoghue, G, et al. : Base station prehospital care: Judgement error and deviations from protocol. Ann Emerg Med 1987;16:867–871.CrossRefGoogle ScholarPubMed
9. Holroyd, BR, Knoff, R, Kallsen, G: Medical control; Quality assurance in prehospital care. JAMA 1986;256:1027–1031.CrossRefGoogle ScholarPubMed
10. Cales, RH: Advanced life support in prehospital trauma care: An intervention in search of an indication? (ed). Ann Emerg Med 1988;17:651–653.CrossRefGoogle ScholarPubMed
11. Salomone, JA: Field times (ed). Ann Emerg Med 1989; 18:1128.CrossRefGoogle ScholarPubMed