PHILADELPHIA FIRE DEPARTMENT EMS PROCEDURE #10 SUBJECT: MEDICAL COMMAND COMMUNICATIONS 1. PURPOSE To establish and set forth the procedure for a Philadelphia Fire Department (PFD) paramedic or firefighter emergency medical technician (EMT) to contact an authorized Medical Command Physician for the purpose of receiving pre-hospital On-Line Medical Command (OLMC) for patient care at the time of a medical emergency. 2. DEFINITIONS 2.1 ON-LINE MEDICAL COMMAND (OLMC) Instructions given to a PFD paramedic or firefighter EMT by an authorized Medical Command Physician who meets the qualifications prescribed by the Commonwealth of Pennsylvania Department of Health, Division of Emergency Medical Services (EMS). OLMC is provided by one of five accredited Medical Command Facilities in accordance with EMS Procedure #13, the Pennsylvania Statewide Advanced Life Support Protocols and/or EMS Procedure #21 Pennsylvania Statewide Basic Life Support Protocols. 2.2 MEDICAL COMMAND FACILITY A hospital under contract to the City of Philadelphia and authorized to provide OLMC to PFD paramedics and firefighter EMTs. Currently, the following hospitals function as Medical Command Facilities: 2.2.1 Albert Einstein Medical Center (AEMC)* 2.2.2 Children s Hospital of Philadelphia (CHOP) for patients 14 years of age 2.2.3 Hospital of the University of Pennsylvania (HUP)* 2.2.4 Temple University Hospital (TUH)* 2.2.5 Thomas Jefferson University Hospital (TJUH)* *Hospitals to be used for patients 15 years of age. 1
2.3 MEDICAL COMMAND PHYSICIAN A physician licensed in the Commonwealth of Pennsylvania who meets the criteria set forth by the Pennsylvania Department of Health for a Medical Command Physician and who is approved by the Philadelphia Regional EMS Council Medical Director to provide OLMC to PFD paramedics and Emergency Medical Technicians (EMT). 2.4 PHYSICIAN OR REGISTERED NURSE ON-SCENE POLICY A policy and procedure to be used by PFD paramedics and firefighter EMTs when, during patient care, a physician or registered nurse who is not part of the PFD/EMS System seeks to intervene in the care and treatment of a patient. (Ref. EMS Procedure #10, Section 4.3) 3. RESPONSIBILITY All EMS personnel, uniformed and non-uniformed, will familiarize themselves with the content of this EMS Procedure and meet their responsibilities in relation to the Fire Department orders and/or policies. 4. PROCEDURES 4.1 ON-LINE MEDICAL COMMAND (OLMC) 4.1.1 Medical Command communication is established via land-line, cellular telephone or radio communication to provide and receive patient-care direction. Medical Command Communication is authorized only between Fire Department paramedics/firefighter EMTs and authorized OLMC Physicians. Fire Department paramedics and firefighter EMTs may not seek or accept medical direction from other physician(s) except in accordance with the Physician On-Scene Policy. Advance alerting of receiving hospitals is the responsibility of the OLMC Physician, and/or the Fire Communication Center (FCC) Dispatcher. 4.1.2 Paramedics and firefighter EMTs will not seek OLMC for patients who are not present for treatment; i.e., left the scene. However, full documentation of the dispatch/patient encounter is still required. 2
4.1.3 Medical Command Communications Equipment a. The land-line telephone should be the first choice of communication (subject to patient proximity). The majority of residences and businesses have telephones that are readily available. b. The cellular telephone should be used whenever a land-line telephone is not available. The cellular telephone is restricted to Emergency Use Only. Routine Calls, such as: Medic Unit times, EMS Field Supervisor (ES-4/-5), answering messages, etc. should wait until a land-line telephone is available. c. Radio communication for OLMC is available through the FCC. The FCC Dispatcher will relay the patient-care information from the paramedic or firefighter EMT to the Medical Command Physician. This would only occur in an extreme situation where the first two means of communication were unsuccessful. 4.1.4 Paramedics and firefighter EMTs shall initiate patient treatment in accordance with the Pennsylvania Statewide Protocols (Basic Life Support and Advanced Life Support) prior to establishing OLMC. Communication shall then be established as rapidly as possible, consistent with the direction of each protocol in the PA State Protocols. Reports to OLMC Physicians shall follow the format presented in EMS Procedure #13, Section VII, S. 50, On-Line Medical Communications. 4.1.5 If the patient s condition changes after OLMC has been completed, and the course of treatment needs to be changed, the paramedic must re-establish OLMC to report the change in patient condition and obtain authorization to alter the previously established treatment plan. In the event this is not possible, the paramedic must document on the Mobile Data Terminal (MDT)/PA EMS Report the change in the patient s condition and the altered treatment. 4.1.6 OLMC Physicians will provide medical management in accordance with current Pennsylvania Statewide Basic Life Support and Advanced Life Support Protocols unless, in their medical judgement, a deviation from the protocol is warranted. 3
4.1.7 OLMC Physicians, when deviating from the protocol, will do so within the scope of practice, equipment, and medication supply of the paramedics and firefighter EMTs. The OLMC Physician will identify the deviation with a brief explanation to the paramedic or firefighter EMT, as appropriate, and the paramedic shall record this information on the MDT/PA EMS Report. The OLMC Physician will also record the deviation from protocol on the Medical Command Control Form for review by the Medical Command Facility Medical Director and the PFD Medical Director. 4.1.8 In the event the OLMC Physician s deviation from the Pennsylvania Statewide Protocols is so at variance from accepted medical practice, as to result in potential or actual harm to the patient, the paramedic may refuse to carry out the deviating order and continue with standard therapy according to written protocol. The EMS provider must so advise the Medical Command Physician. The EMS provider must then: a. record the incident on the MDT/PA EMS Report b. immediately notify the EMS Field Supervisor c. send a follow-up memorandum to the Medical Director, through the EMS Field Supervisor, noting all of the particulars of the incident. 4.2 OLMC FAILURE When OLMC fails due to technical reasons, Fire Department paramedics and firefighter EMTs will complete the applicable procedures in the Pennsylvania Statewide Basic Life Support and Advanced Life Support Protocols and transport the patient. The Fire Department s Emergency Medical Services (EMS) Continuous Quality Improvement Unit (CQI) will evaluate each case for appropriateness of care and protocol compliance. Accordingly, in the event that Fire Department paramedics or firefighter EMTs are unable to establish or maintain communication with the OLMC Physician, they are to follow Pennsylvania Statewide Basic Life Support and Advanced Life Support Protocols as the written order(s) of the Philadelphia Fire Department Medical Director. 4
4.2.1 On the EMS Reporting document, make the following entries: EMS PROCEDURE #10 a. on the MDT narrative screen, type OLMC Failure at the end of the narrative, and include the name of the hospital you were attempting to contact and the nature of the failure. b. on the PA EMS Report (paper report) two entries should be made. On the bubble side darken the bubble corresponding to the word Protocol in the Medical Command field. On the narrative side add OLMC Failure at the end of the narrative, and include the name of the hospital you were attempting to contact and the nature of the failure. 4.2.2 The paramedic or firefighter EMT will then notify the EMS Field Supervisor, who will subsequently take the necessary steps and make notifications to rectify the problem. 4.3 PHYSICIAN OR REGISTERED NURSE ON-SCENE POLICY If a physician or registered nurse (RN) offers to provide assistance with patient care, the paramedic or firefighter EMT is to follow the On-Scene Physician/RN Statewide BLS Protocol of the Pennsylvania Statewide Basic Life Support Protocols (Ref. EMS Procedure #21). Note: If problems arise and cannot be resolved, move to a nearby stable environment, and proceed under the PA State Protocols. BY ORDER OF THE FIRE COMMISSIONER 5
APPENDIX A PHILADELPHIA FIRE DEPARTMENT EMERGENCY MEDICAL SERVICES MEDICAL COMMAND FACILITIES AND MEDIC UNIT ASSIGNMENTS AEMC (Albert Einstein Medical Center)* MEDICS: 06, 12, 18, 20, 24, 29, 33, 38, ID# 2706 45B, 46B, 47B, 48B, 49B TELEPHONE: 215-685-9177 HUP (Hosp. Univ. PA)* MEDICS: 03, 9B, 19, 23, 26, 30, 34, 36, ID# 3411 40, 41B, 42B, 50B TELEPHONE: 215-685-7696 TJUH (Thomas Jefferson Univ. Hosp.)* MEDICS: 01, 07, 11, 14B, 15, 21, 27, 35, ID# 2008 37, 43B, 44B TELEPHONE: 215-686-1310 TUH (Temple Univ. Hosp.)* MEDICS: 02, 4B, 05, 8B, 10, 13, 16, 17, ID# 2007 22, 25, 28, 31, 32, 39 TELEPHONE: 215-685-9758 CHOP (Children s Hosp of Phila.) ID# 5504 TELEPHONE: MEDICAL COMMAND FACILITY FOR ALL PATIENTS 14 YEARS OF AGE. * Medical Command Facility for all patients 15 years of age. BY ORDER OF THE FIRE COMMISSIONER 6