By Caitlyn Williams, EMT
Upon becoming a licensed EMS provider, it is the expectation that you are trained and qualified to make quick and accurate decisions in high-stress environments. In order to make these sometimes life-or-death decisions, we often rely on our own judgment and experience in the field.
An important, yet often overlooked, aspect in achieving positive patient outcomes involves leveraging the knowledge, training and expertise of others. The most efficient way to receive this additional help is by contacting medical control, the system that connects EMS providers with physicians or other medical professionals.
Reaching out to medical control provides an additional perspective, one enriched by years of medical experience and superior training in many different aspects of clinical care.
Medical control is typically contacted via cell phone or radio. EMS providers will reach out to their dispatch and request a line to the hospital they are en route to, with the call being forwarded to the on-call medical director.
EMS providers typically contact medical control in situations that require the knowledge of a higher scope of practice, or because the patient’s condition has significantly changed en route and guidance is needed.
This access to a higher level of care should positively influence the number of calls made to medical control. However, certain factors may be impeding this process. If such factors exist, what are they?
We conducted a survey addressed to EMS providers working in different services across Middle Tennessee to identify the most common barriers they encounter when reaching out to medical control.
Our aim is to identify any potential areas for improvement. Sixty-five people participated in this survey, and the data presented below is from their responses. IRB approval was not needed.
The first area identified for improvement addresses the relationship between EMS providers and medical control. When surveyed, 95.6% of EMS providers expressed that medical control consultations enhanced patient care, yet only 83% felt comfortable contacting and requesting this assistance.
One reason for this is the concern of appearing incompetent to medical control and/or other staff members. One paramedic had this to say in regards to the backlash given after contacting medical control: “Though most of the staff is incredibly kind and receptive to questions, there have been discussions of people behind their back where people criticize their ‘incompetence’ and care choices.”
Another EMT agreed with this sentiment and said, “I often fear my peers will perceive my request for consultation as incompetence or lack of ability to critically think.” These comments were not uncommon and suggest a major disconnect between EMS and professionals of higher levels of care.
One way to fix this disconnect is by encouraging EMS agencies to implement support systems that aim to alleviate any concerns that their EMTs and paramedics bring up, especially in regards to asking for help. This may include offering support networks or mentorship programs where EMS providers can seek advice as well as share experiences to learn from each other.
Another way to bridge the gap between EMS and medical control is by having ER physicians ride along with their local 911 services to understand how we operate and to build relationships with the crews. Establishing a culture that values collaboration and encourages open communication is what ultimately allows providers to feel empowered to seek guidance without fear of judgment.
An additional significant finding was that 29% of surveyors had not received formal training on how and when to contact medical control, which may be a contributing factor to EMS providers’ reluctance to reach out to medical control.
One way to address this is to implement quarterly medical control training, where scripts and scenarios are practiced so that medical control personnel can recognize the format of the information EMS providers are trying to convey. SBAR or MIST (Mechanism, Inspection/Injuries, Signs, Treatments) are the most commonly used formats between EMS and medical control. In these formats, EMS providers start the conversation with the reason for the call, whether it’s for advice, orders, or termination of efforts, and then follow up with the supporting details.
In addition to practicing scripts, targeted training scenarios could be implemented where EMS personnel are encouraged, if not expected, to contact medical control. These case-based scenarios should focus on reinforcing the importance of medical control consultations and providing guidance on when and how to initiate these interactions.
By equipping EMS providers with the necessary skills and confidence through this training, we can foster a culture where seeking medical control assistance is seen as a standard practice rather than an exception, which will ultimately enhance patient care outcomes.
Training is only effective, however, if there is a process in place to evaluate and ensure that it is working. Most states require that medical control calls be recorded, which is beneficial, but any EMS service that lacks a quality assurance or improvement process for those recordings is missing a valuable opportunity to enhance communication between medical control and EMS providers. Such processes can help evaluate the effectiveness of these consultations and identify areas for improvement in these interactions.
Furthermore, when asked what barriers EMS providers were facing when contacting medical control, 79.63% of surveyors mentioned that their biggest issue involved the amount of time it takes to get to the right person, due to various reasons.
One surveyor said, “The worst barrier is when the doctor on call doesn’t answer the phone.”
Another said, “I recently attempted to call medical control twice on a patient and was not able to get ahold of them due to them having the wrong number.”
These findings surface additional questions regarding timing and how it plays a role in prehospital decision-making.
Some of these questions include:
- What are the most significant time-related barriers that exist between EMS providers and medical control?
- Is there a standard for how long it takes to reach a medical director, and, if so, is there a quality improvement process to ensure that those standards are being upheld?
- What is an acceptable time delay between the initial contact and when the EMS provider gets an order/answer?
- Does the risk of a time delay outweigh the potential benefit of taking extra time to find a specialist better suited to answer medical control questions, such as in cases requiring OB or pediatric expertise?
Medical control consultations play a pivotal role in the prehospital care setting and should be utilized by EMS whenever necessary. Under-usage of this invaluable tool only hinders our ability to provide the best possible care to our patients.
To prevent this, we have identified a few ways to bridge the gaps between medical control and EMS providers. We have also identified new areas for research regarding how long it takes to reach and receive orders from medical control and how this could possibly be affecting patient care outcomes.
Finding the answers to these questions will undoubtedly enable us all to fulfill our roles as providers of cutting-edge, high-quality patient care.
Caitlyn Williams is an EMT for Vanderbilt Lifeflight in Nashville, Tennessee.
