Medical Control

The EMS system initiated centralized medical command in January 1990 through the staff of the Medical Director’s Office. The program continues today under the same basic premise, but is now recognized as "On-Line Medical Control" (OLMC). OLMC remains available to our field clinicians 24 hours a day, seven days a week. It is a real-time quality assurance (QA) mechanism for the patient care being provided by EMS system paramedics. The program is provided with a core group of Board-Certified emergency physicians and two clinical supervisors called "Medical Officers of the Day" (MOD), who are selected by the medical director for their superior experience and knowledge.

According to our contract with the EMS Authority, OLMC is to be provided by the medical director, EMS physician fellows, emergency physicians, emergency medicine residents, and medical officers. The system medical director extends clinical privileges to these individuals after they meet the credentialing requirements outlined in the Pinellas County EMS Rules and Regulations. Each member successfully completes an orientation and probation program and participates in OLMC staff meetings.

The purpose of OLMC is to provide field personnel access to clinical consultations. It provides an opportunity to discuss the patient’s clinical presentation and any alternatives to treatment on a real-time basis. Contact with OLMC is required when care reaches a prescribed "trigger point" during patient care.

Since its institution, OLMC has, in itself, altered the EMS System in a variety of ways:

• Continued review and evaluation of medical protocols
• QA of system personnel on a real-time basis
• The management of hospital bypass problems or requests for variance in policy when appropriate
• Real-time assessment of system training on current standards of care
• Making sure that patients’ needs are best served by transport to an appropriate emergency facility
• Advice on a myriad of risk management issues, most often times leading to risk avoidance
• Reliable alert to the hospital team of a patient’s impending arrival and suggestions for appropriate preparations
• Real-time follow up with field clinicians on difficult cases
• If requested, making a field response to multi-casualty incidents or a scene in which direct medical control is warranted.

The OLMC program is a major system resource for improving the quality of care given to our patients. Originally, the design of this program was to exclusively use EMS physicians. However, we have experienced great success with the utilization of medical officers as primary OLMC resources, along with our EMS physicians. The medical officer concept was approved by the Medical Control Board (MCB) on April 4, 1990, and has continually been a fundamental component of the program.

Our current staff of medical officers provides significant benefits to the system due to having a familiarity with the field environment and a thorough understanding of system protocols and procedures, as they help design and train personnel on them on a regular basis. Further, the ready availability of our medical officers from our in-house staff affords tremendous flexibility in coverage during unexpected scheduling conflicts, meetings, vacations, and sickness that may deplete our physician OLMC staff.

Whenever a medical officer provides primary consultation services, there is a staff OLMC physician with direct responsibility for additional consultation as required. Our system actually has 100% physician coverage available to field paramedics at all times when it is necessary.