Peter Canning has been writing about the 16 biggest treatment changes over his 20 years as a paramedic. He starts his list by emphasizing the positive –
Increased Standing Orders.[1]
I would probably emphasize the negative –
Decreased Mother-May-I Restrictions.
I am not criticizing Peter’s style. He has made a living as a writer before becoming a paramedic and has added to that by writing a couple of books after becoming a paramedic. I am just easing my way toward why I emphasize the negative of these requirements.
As with many other things I write about, there has never been any evidence that Mother-May-I restrictions OLMC (On-Line Medical Command) permission requirements provide any benefit. There is plenty of evidence of harm to patients from these obstacles to patient care.[2],[3]
We would be much better off with more aggressive oversight of EMS by medical directors. This magic phone call is not oversight, but only smoke and mirrors.
–
–
Then there is the bigger problem – the ridiculous idea of They have to call to do anything dangerous.
High flow oxygen has been a standing order requirement in many of these Mother-May-I systems. High flow oxygen is almost always harmful to our patients.
Dangerous paramedics need to be remediated, and if they cannot be remediated they should be terminated, not given a magic safety phone to use in cases where a competent medic is needed.
–
Go read the rest of the not-yet-completed list of 16 biggest changes in EMS over the past 20 years.
–
Footnotes:
–
[1] Increased Standing Orders
Street Watch: Notes of a Paramedic
March 31, 2012
Article
–
[2] Refusal of base station physicians to authorize narcotic analgesia.
Gabbay DS, Dickinson ET.
Prehosp Emerg Care. 2001 Jul-Sep;5(3):293-5. No abstract available.
PMID: 11446548 [PubMed – indexed for MEDLINE]
We report two cases where paramedics’ requests for intravenous (IV) morphine to treat isolated extremity injuries were refused by base station physicians providing online medical oversight because those physicians felt that the use of morphine would alter the patient’s ability to be consented for potential surgery after arrival at the hospital.
–
[3] Effects of on-line medical control in the prehospital treatment of atraumatic illness.
Klein KR, Spillane LL, Chiumento S, Schneider SM.
Prehosp Emerg Care. 1997 Apr-Jun;1(2):80-4.
PMID: 9709343 [PubMed – indexed for MEDLINE]
CONCLUSIONS:
OLMC does not improve adherence to protocol or the quality of care provided in the treatment of atraumatic illness.
.