On-line medical direction: a prospective study.
OBJECTIVE
To determine the frequency with which physician, on-line medical direction (OLMD) [direct medical control] of prehospital care results in orders, to describe the nature of these orders, and to measure OLMD time intervals.


METHODS
Blinded, prospective study.


METHODS
A university hospital base-station resource center.


METHODS
Ten emergency physicians, 50 advanced life support providers.


METHODS
Prehospital treatment was directed by both standing orders and OLMD physician orders. Independent observers recorded event times and the characteristics of OLMD.


RESULTS
Physician orders were given in 47 (19%) of the 245 study cases, and covered a variety of interventions, including many already authorized by standing orders. Mean OLMD radio time was four minutes (245 +/- 216 seconds [sec]), and time from beginning of OLMD to hospital arrival averaged 12 minutes (718 +/- 439 sec). Mean transport time in this system was 13 minutes.


CONCLUSIONS
Despite detailed standing orders, OLMD results in orders for clinical interventions in 19% of cases. On-line medical direction requires about four minutes of physician time per call. This constituted about one-third of the potential field treatment time interval in this system. Thus, OLMD appears to play an important role in providing quality prehospital care.
Wuerz
R C
RC
Center for Emergency Medical Services, Milton S. Hershey Medical Center, Pennsylvania State University, Hershey 17033, USA.
Swope
G E
GE
Holliman
C J
CJ
Vazquez-de Miguel
G
G
D002985:Clinical Protocols; D004631:Emergency Medical Service Communication Systems / Q000706:statistics & numerical data*; D004632:Emergency Medical Services / Q000458:organization & administration*; D006302:Health Services Research; D006801:Humans; D008505:Medical Staff, Hospital; D009862:Online Systems / Q000706:statistics & numerical data*; D010819:Physician's Role; D011446:Prospective Studies; D016037:Single-Blind Method; D013997:Time Factors; D014481:United States