On-line medical direction: a prospective study

Abstract

Objectives: 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.

Setting: A university hospital base-station resource center.

Participants: Ten emergency physicians, 50 advanced life support providers.

Interventions: 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.

Conclusion: 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.