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Safe Out-of-Hospital Treatment of Chest Pain Without Direct Medical Control

Published online by Cambridge University Press:  28 June 2012

Mara McErlean ,
Nancy Raccio-Robak ,
Joel M. Bartfield  and
Daniel Hermes
Mara McErlean*
Affiliation:
Department of Emergency Medicine, Albany Medical Center, Albany, New York
Nancy Raccio-Robak
Affiliation:
Department of Emergency Medicine, Albany Medical Center, Albany, New York
Joel M. Bartfield
Affiliation:
Department of Emergency Medicine, Albany Medical Center, Albany, New York
Daniel Hermes
Affiliation:
Department of Emergency Medicine, Albany Medical Center, Albany, New York
*
Department of Emergency Medicine, Albany Medical Center, A-139, 43 New Scotland Ave., Albany, NY 12208-3478USA
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Abstract

Introduction:

The use of direct medical control (DMC) in the out-of-hospital setting often is beneficial, but has the disadvantage of consuming emergency medical services (EMS) resources.

Hypothesis:

Uncomplicated, nontrauma, adult patients with chest pain can be treated safely and transported by paramedics without DMC.

Methods:

Retrospective chart review of all nontrauma, adult patients with chest pain treated in a combined rural and suburban EMS system during a 2-year period (December 1990 through November 1992) was conducted. Before November 1991, DMC was mandatory for all patients with chest pain. Beginning 01 November 1991, if a patient had resolution of pain either spontaneously, with administration of oxygen, or after a single dose of nitroglycerin, DMC was at the discretion of the paramedic. Using the above criteria for inclusion, three study groups were defined: Group 1, before protocol change; Group 2, after protocol change without DMC; and Group 3, after protocol change when physician contact was obtained, but not required. These groups were compared for the following parameters: 1) scene time; 2) time to administration of first dose of nitroglycerin; 3) time interval between measurement of vital signs; 4) oxygen use; 5) intravenous access; and 6) electrocardiographic monitoring. Continuous and categorical variables were analyzed by multivariate and univariate analysis of variance and chi-square tests, respectively.

Results:

Of 308 nontrauma, adult patients with chest pain, 71 met inclusion criteria in Group 1, 40 in Group 2, and 34 in Group 3. No statistically significant differences were identified in any of the study parameters.

Conclusion:

Adult patients with chest pain who have no other symptoms or complicating conditions can be treated appropriately by paramedics without DMC.

Keywords

base stationchest paindirect medical controlemergency medical servicesmedical commandnitroglycerinparamedicsprotocolout-of-hospital timestanding orders
Type
Original Research
Information
Prehospital and Disaster Medicine , Volume 11 , Issue 1 , March 1996 , pp. 16 - 19
Copyright
Copyright © World Association for Disaster and Emergency Medicine 1996

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Footnotes

*Presented at the National Association of Emergency Medical Services Physicians' Annual Scientific Assembly, Minneapolis, Minnesota, 10 June 1993

References

1. American College of Emergency Physicians: Position Statement—Medical control of prehospital emergency medical services. Ann Emerg Med 1982;11:387.CrossRefGoogle Scholar
2. Holroyd, BR, Knopp, R, Kallsen, G: Medical control: Quality assurance in prehospital care. JAMA 1986;256:1027–1031.CrossRefGoogle ScholarPubMed
3. Cwinn, AA, Pons, PT, Moore, EE, et al. : Prehospital advanced trauma life support for critical blunt trauma victims. Ann Emerg Med 1987;16:399–403.CrossRefGoogle ScholarPubMed
4. Spaite, DW, Tse, DJ, Valenzuela, TD, et al. : The impact of injury severity and prehospital procedures on scene time in victims of major trauma. Ann Emerg Med 1991;20:1299–1305.CrossRefGoogle ScholarPubMed
5. Hunt, RC, Bass, RR, Graham, RG, et al. : Standing orders vs voice control—A study measures the effects of standing orders on paramedic prehospital treatment of cardiopulmonary arrest. Journal of Emergency Medical Services 1982;7:26–31.Google Scholar
6. Erder, MH, Davidson, SJ, Cheney, RA: On-line medical command in theory and practice. Ann Emerg Med 1989;18:261–268.CrossRefGoogle ScholarPubMed
7. Thompson, SJ, Schriver, JA: A survey of prehospital care paramedic/physician communication for Multnomah County (Portland) Oregon. Journal of Emergency Medical Services 1985;1:421–428.CrossRefGoogle Scholar
8. Wasserberger, J, Ordog, GJ, Donoghue, G, et al. : Base-station prehospital care: Judgment errors and deviations from protocol. Ann Emerg Med 1987;16:867–871.CrossRefGoogle ScholarPubMed
9. Holliman, CJ, Wuerz, RC, Meador, SA: Decrease in medical command errors with use of a “standing orders” protocol system. Am J Emerg Med 1994;12:279–283.CrossRefGoogle ScholarPubMed
10. Hoffman, JR, Luo, J, Schriger, DL, et al. : Does paramedic-base hospital contact result in beneficial deviations from standard prehospital protocols? West J Med 1990;153:283–287.Google ScholarPubMed
11. Pointer, JE, Osur, M: Effect of standing orders on field times. Ann Emerg Med 1989;18:1119–1121.CrossRefGoogle ScholarPubMed
12. 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