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| BroMenn/St. Joseph EMS Systems | Policy and Procedure Manual |
TITLE: RESOURCE HOSPITAL MEDICAL CONTROL "OVERRIDES"
POLICY STATEMENT:
BroMenn Regional Medical Center functions as the Base State Medical Control for the BroMenn Service Area EMS System. St. Joseph Medical Center functions as the Base Station Medical Control for the St. Joseph Medical Center EMS System. However, if Associate Hospitals of either EMS System are assigned Medical Control responsibilities, the respective Resource Hospital reserve the right to override the delegated medical control to assure appropriate patient care.
GOAL/PURPOSE:
To assure a mechanism whereby either Resource Hospital will override a managing hospital's orders in an appropriate and ethical fashion.
POLICY/PROCEDURE:
A. Definition:
An override call occurs when Resource Hospital personnel intercede the
medical direction of a pre-hospital call directed by an Associate Hospital.
The override may be requested by the EMT-B, EMT-I, EMT-P, ECRN, Pre-hospital
RN and initiated by the on-duty Medical Control Emergency Department Physician
at the Resource Hospital.
B. Indications for Override
1. When the original medical control of the call by Associate Hospital personnel could result in unreasonable or medically inaccurate treatment causing potential harm to the patient.
2. Undue delay in initiating transport of a critically ill patient. (Greater than 20 minutes)
3. When there is no response from the Associate Hospital to the EMT or Pre-hospital RN after tree (3) attempts to contact.
C. Intervention
1. Associate Hospitals of the BroMenn and St. Joseph EMS Systems are located in communities at a distance greater that 30 miles. The Associate Hospitals of both EMS Systems only serve as medical control for EMT-B and EMT-I affiliate agencies and do not have ALS telemetry radio communications. The Associate Hospitals utilize the MERCI radio or direct telecommunications via in-field cellular link to communicate with EMS affiliate agencies.
2. If the pre-hospital care provider encounters an indication for a Resource Hospital override, the EMT/Pre-hospital RN shall notify the Associate Hospital with the request for override and terminate communications the Associate Hospital
3. The pre-hospital care provider shall then contact respective Resource Hospital and notify the Medical Control Emergency Department Physician of their determination for override and relay the patient's pertinent medical history and condition for appropriate medical control guidance.
4. After medical control guidance has been completed, the Resource Hospital Medical Control physician shall notify the Associate Hospital Medical Control physician that an override was initiated and completed. All pertinent information shall be conveyed to the Associate Hospital medical control regarding an up-date on the patient's medical status and the pre-hospital treatment rendered. The Associate Hospital shall be given an Estimated Time of Arrival of the patient to their facility.
5. The Resource Hospital Medical Control Physician and the EMS provider shall both submit, in their own perspective, a written summary of the intervention, including the reason(s) for the requested, granted/denied resource hospital override. The summary shall be written on a BroMenn/St. Joseph EMS Systems "Incident Report Form" and submitted to the respective EMS System Coordinator.
6. A summary of the intervention shall also be written by the Associate Hospital Medical Control physician and submitted to the respective EMS System Coordinator.
7. The EMS System Coordinator shall collate all written Incident Reports and forward them to the President of the BroMenn/St. Joseph EMS Quality Council for a final determination and recommendation by the Council to the appropriate EMS Medical Director.
8. Only those physicians listed below may grant or deny a request for Resource Hospital Medical Control Override.
a. EMS Medical Directors
b. Associate EMS Medical Directors
c. On-duty Emergency Department physicians at the BroMenn Regional Medical Center and St. Joseph Medical Center.
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