Ems Med Dir Prov Survey
Transcript of Ems Med Dir Prov Survey
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Texas EMS Medical DirectorsSurvey&
Medical Direction from the ProvidersPerspective
An Assessment of Online and Offline
Medical Direction in Texas
This project has been funded by the Emergency Medical Services for
Children (EMSC) State Partnership Grant from the Health Resources
and Services Administration (HRSA) H33MC11305
Anthony Gilchrest, MPA, Charles Macias, MD, MPH, Manish Shah, MD
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BACKGROUND
Universally available online medical control is absent in 38% ofEmergency Medical Services (EMS) agencies in Texas
Barriers to online medical control in Texas have not beenpreviously described
76% of EMS agency leaders (non-physicians)desire online
medical control from a base station at a regional childrenshospital
75% of EMS agency leaders (non-physicians) would use EMS forChildren (EMSC)-created evidence-based (EB) pediatricprotocols
No data exists on current utilization of pediatricspecific onlinemedical control in Texas
Medical directors perspectives on online and offline medicaldirection in Texas have not been previously assessed
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OBJECTIVES
To identify common barriers and exploreacceptability of potential solutions for onlinemedical control
To describe EMS providers and medicaldirectors experiences with medical direction
To measure current utilization of pediatric onlinemedical control
To provide the medical directors perspective onregional pediatric online medical control andwritten protocols
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METHODS
Study Design and Setting:
Cross sectional survey of EMS providers
attending 2011 Texas EMS Conference
Cross sectional online survey of all medicaldirectors of 911-responding EMS agencies in
Texas
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METHODS
Inclusion Criteria: EMS personnel currently working or volunteering for
a ground transport ambulance service in Texas
Physician medical directors for 911-responding
ground ambulance services in Texas Data Analysis
Descriptive statistics were used to report frequencyof responses
Identical and similar questions from each surveywere grouped by question type and presented inside-by-side comparison
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RESULTS
Agency Representation 93% 911-responding EMS
agencies
38% non fire-based, public
32% fire-based14% private for profit
7% hospital-based
58% all paid
25% combination
15% all volunteer
90% Advanced Life Support(ALS)
38% rural; 30% urban;
25% suburban; 7% frontier
EMS Provider Survey 105 EMS providers
surveyed
16 declined; 5 excluded
84 (80%) surveysanalyzed
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RESULTS
EMS Medical DirectorSurvey 319 medical directors
surveyed
3 declined; 14 excluded
127 (40%) surveysanalyzed
59% have attended an
EMS Medical Directorscourse
Agency Representation 43% fire-based
37% non fire-based, public18% private for profit
17% hospital-based
11% non-profit
52% all paid
40% combination
5% all volunteer
94% ALS
61% rural; 36% urban
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AGENCY MONTHLY CALL VOLUME
Average Median Mode
Total Monthly Call Vol 1715 400 500
0
200
400
600
800
1000
1200
1400
1600
1800
2000
Runspermonth
Total Monthly Call Volume
AVG1715
Median
400
Mode
500
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ONLINE MEDIC L CONTROL LL P TIENTS
Average Median Mode Average Median Mode
On-Line All 51 10 10 24 5.5 2
0
10
20
30
40
50
60
On-linecallspermonth
Estimated Monthly online medical control all patients
51 Urban Rural
24
(Calls for medical advice other than routine notification)
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ONLINE MEDICAL CONTROL PEDIATRICS
Average Median Mode Average Median Mode
On-Line Peds 12 2.5 2 4 1 1
0
2
4
6
8
10
12
14
O
n-linecallspermonth
Estimated Monthly on-line medical control pediatric patients
12 Urban Rural
4
(Calls for medical advice other than routine notification)
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PERCENTAGE OF PEDIATRIC CALLS
21%
79%
Pediatrics make up 21% of allcalls for online medical
controlOn-Line Peds Non-Peds
On-LinePeds24%
Non-Peds76%
24% of calls to medical controlin urban setting
On-Line
Peds16%
Non-Peds84%
16 % in rural and frontier areas
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CAUSES FOR COMMUNICATION FAILURES
EMS Providers Medical Directors
Reported communication
difficulties when attempting to
contact online medical control
Reported causes for online medical
control communication failures
investigated by MD
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PRIMARY SOURCE OF MEDICAL CONTROL
Primary source of online medical
control
Medical director or designee provides
online medical control
EMS Providers Medical Directors
13%
14%
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ALTERNATIVE SOURCE DYNAMICS
49% do not knowskill/training of physicianproviding medicaldirection
43% reported thatmedical control physicianwould not know writtenprotocols
14 % would not know
training or skill level ofEMS providers
80% report they do notreceive QA/QI fromphysician/agency
providing medical control
Someoneother thanAgencyMedicalDirector
28%
Of those reporting that someoneother than the agency medical
director provides online medical
control:
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PROTOCOL/ORDER DISCORDANCE
EMS providers that received online
orders that contradict written
protocol
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PEDIATRIC MEDICAL DIRECTION
Medical Director Perspectives Agree Disagree Dontknow
Standardized, EB regional pediatric
protocols would improve quality of
care79% 5% 9%
Pediatric online medical control from
a pediatric emergency medicine
(PEM) specialist has the potential to
improve quality73% 11% 8%
Would consider utilizing onlinemedical control from a base station
at regional pediatric center72% 9% 11%
Would consider using EMSC
created EB pediatric protocols 82% 3% 8%
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PEDIATRIC MEDICAL DIRECTION
Medical Director Perspectives Agree Disagree Dont
know
Varied protocols within a given
region would be a significant barrier
to regionalized online medical
control
63% 15% 14%
Varied EMS provider certification
level/scopes of practice within a
given region would be a significant
barrier to regionalized online
medical control
59% 21% 13%
Perceived Barriers to Regional Online Medical Control
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LIMITATIONS
Limited sample sizes
Selection bias for EMS provider survey:
respondents at Texas EMS Conference were
disproportionately ALS level providers
37% unknown or missing for monthly on-line
volumes average
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CONCLUSIONS
Common barriers to online medical control (OLMC) include
Poor cell phone and radio reception
No answer to call or no physician available
Someone other than the medical director or designated
physician is frequently the expected resource for OLMC
Pediatric OLMC utilization (21%) is disproportionately higherthan EMS pediatric transports (10%)
Calls for pediatric OLMC in the rural setting are rare
Standardized, evidence-based, regional pediatric protocols
and base stations are strongly supported by medical
directors
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NEXT STEPS
Continue to develop Pediatric ProtocolResource with EB literature summaries andguidelines for use in the creation of morestandardized local and regional EB pediatricprotocols
Work with GETAC committees, medicaldirectors, EMS agencies, childrens hospitals
and community hospitals to enhance currentonline medical control communicationinfrastructure