Ems Med Dir Prov Survey

8/12/2019 Ems Med Dir Prov Survey

1/20

Texas EMS Medical DirectorsSurvey&

Medical Direction from the ProvidersPerspective

An Assessment of Online and Offline

Medical Direction in Texas

This project has been funded by the Emergency Medical Services for

Children (EMSC) State Partnership Grant from the Health Resources

and Services Administration (HRSA) H33MC11305

Anthony Gilchrest, MPA, Charles Macias, MD, MPH, Manish Shah, MD


2/20

BACKGROUND

Universally available online medical control is absent in 38% ofEmergency Medical Services (EMS) agencies in Texas

Barriers to online medical control in Texas have not beenpreviously described

76% of EMS agency leaders (non-physicians)desire online

medical control from a base station at a regional childrenshospital

75% of EMS agency leaders (non-physicians) would use EMS forChildren (EMSC)-created evidence-based (EB) pediatricprotocols

No data exists on current utilization of pediatricspecific onlinemedical control in Texas

Medical directors perspectives on online and offline medicaldirection in Texas have not been previously assessed


3/20

OBJECTIVES

To identify common barriers and exploreacceptability of potential solutions for onlinemedical control

To describe EMS providers and medicaldirectors experiences with medical direction

To measure current utilization of pediatric onlinemedical control

To provide the medical directors perspective onregional pediatric online medical control andwritten protocols


4/20

METHODS

Study Design and Setting:

Cross sectional survey of EMS providers

attending 2011 Texas EMS Conference

Cross sectional online survey of all medicaldirectors of 911-responding EMS agencies in

Texas


5/20

METHODS

Inclusion Criteria: EMS personnel currently working or volunteering for

a ground transport ambulance service in Texas

Physician medical directors for 911-responding

ground ambulance services in Texas Data Analysis

Descriptive statistics were used to report frequencyof responses

Identical and similar questions from each surveywere grouped by question type and presented inside-by-side comparison


6/20

RESULTS

Agency Representation 93% 911-responding EMS

agencies

38% non fire-based, public

32% fire-based14% private for profit

7% hospital-based

58% all paid

25% combination

15% all volunteer

90% Advanced Life Support(ALS)

38% rural; 30% urban;

25% suburban; 7% frontier

EMS Provider Survey 105 EMS providers

surveyed

16 declined; 5 excluded

84 (80%) surveysanalyzed


7/20

RESULTS

EMS Medical DirectorSurvey 319 medical directors

surveyed

3 declined; 14 excluded

127 (40%) surveysanalyzed

59% have attended an

EMS Medical Directorscourse

Agency Representation 43% fire-based

37% non fire-based, public18% private for profit

17% hospital-based

11% non-profit

52% all paid

40% combination

5% all volunteer

94% ALS

61% rural; 36% urban


8/20

AGENCY MONTHLY CALL VOLUME

Average Median Mode

Total Monthly Call Vol 1715 400 500

0

200

400

600

800

1000

1200

1400

1600

1800

2000

Runspermonth

Total Monthly Call Volume

AVG1715

Median

400

Mode

500


9/20

ONLINE MEDIC L CONTROL LL P TIENTS

Average Median Mode Average Median Mode

On-Line All 51 10 10 24 5.5 2

0

10

20

30

40

50

60

On-linecallspermonth

Estimated Monthly online medical control all patients

51 Urban Rural

24

(Calls for medical advice other than routine notification)


10/20

ONLINE MEDICAL CONTROL PEDIATRICS

Average Median Mode Average Median Mode

On-Line Peds 12 2.5 2 4 1 1

0

2

4

6

8

10

12

14

O

n-linecallspermonth

Estimated Monthly on-line medical control pediatric patients

12 Urban Rural

4

(Calls for medical advice other than routine notification)


11/20

PERCENTAGE OF PEDIATRIC CALLS

21%

79%

Pediatrics make up 21% of allcalls for online medical

controlOn-Line Peds Non-Peds

On-LinePeds24%

Non-Peds76%

24% of calls to medical controlin urban setting

On-Line

Peds16%

Non-Peds84%

16 % in rural and frontier areas


12/20

CAUSES FOR COMMUNICATION FAILURES

EMS Providers Medical Directors

Reported communication

difficulties when attempting to

contact online medical control

Reported causes for online medical

control communication failures

investigated by MD


13/20

PRIMARY SOURCE OF MEDICAL CONTROL

Primary source of online medical

control

Medical director or designee provides

online medical control

EMS Providers Medical Directors

13%

14%


14/20

ALTERNATIVE SOURCE DYNAMICS

49% do not knowskill/training of physicianproviding medicaldirection

43% reported thatmedical control physicianwould not know writtenprotocols

14 % would not know

training or skill level ofEMS providers

80% report they do notreceive QA/QI fromphysician/agency

providing medical control

Someoneother thanAgencyMedicalDirector

28%

Of those reporting that someoneother than the agency medical

director provides online medical

control:


15/20

PROTOCOL/ORDER DISCORDANCE

EMS providers that received online

orders that contradict written

protocol


16/20

PEDIATRIC MEDICAL DIRECTION

Medical Director Perspectives Agree Disagree Dontknow

Standardized, EB regional pediatric

protocols would improve quality of

care79% 5% 9%

Pediatric online medical control from

a pediatric emergency medicine

(PEM) specialist has the potential to

improve quality73% 11% 8%

Would consider utilizing onlinemedical control from a base station

at regional pediatric center72% 9% 11%

Would consider using EMSC

created EB pediatric protocols 82% 3% 8%


17/20

PEDIATRIC MEDICAL DIRECTION

Medical Director Perspectives Agree Disagree Dont

know

Varied protocols within a given

region would be a significant barrier

to regionalized online medical

control

63% 15% 14%

Varied EMS provider certification

level/scopes of practice within a

given region would be a significant

barrier to regionalized online

medical control

59% 21% 13%

Perceived Barriers to Regional Online Medical Control


18/20

LIMITATIONS

Limited sample sizes

Selection bias for EMS provider survey:

respondents at Texas EMS Conference were

disproportionately ALS level providers

37% unknown or missing for monthly on-line

volumes average


19/20

CONCLUSIONS

Common barriers to online medical control (OLMC) include

Poor cell phone and radio reception

No answer to call or no physician available

Someone other than the medical director or designated

physician is frequently the expected resource for OLMC

Pediatric OLMC utilization (21%) is disproportionately higherthan EMS pediatric transports (10%)

Calls for pediatric OLMC in the rural setting are rare

Standardized, evidence-based, regional pediatric protocols

and base stations are strongly supported by medical

directors


20/20

NEXT STEPS

Continue to develop Pediatric ProtocolResource with EB literature summaries andguidelines for use in the creation of morestandardized local and regional EB pediatricprotocols

Work with GETAC committees, medicaldirectors, EMS agencies, childrens hospitals

and community hospitals to enhance currentonline medical control communicationinfrastructure

Documents

Ems Med Dir Prov Survey