Medic Command Calls Slowed a Dysfunctional OSF Emergency Department

While working in the ER at OSF in Peoria the medic command calls rolled in all day long. The calls were from medics in the field who knew what they were doing and their care was protocol driven.

I thought it was largely a waste of time for physicians to answer these calls. And sick patients in the ER and the ER waiting room waited longer because of these calls.

And there was pressure to answer these calls. The number of medic command calls answered by each physician was tallied and distributed at the end of each month.

Why?

EMS in the Peoria Area was based at OSF and still is. And the idea was for OSF to keep control of the Peoria Area EMS. It's all about money as we know. 

The letter to the editor below describes my feelings quite well. 

John 

Emergency Medicine News:

January 2013 - Volume 35 - Issue 1 - p 4

doi: 10.1097/01.EEM.0000425855.74142.40

Letter to the Editor

Letter to the Editor: EMS an EM Mess

Editor:

Maybe it's just me, but has anyone wondered about the efficacy and effectiveness of providing on-line medical command to prehospital care providers?

To me, the medic command calls are just one more senseless interruption, (along with signing crutch forms, signing the PA's charts, and looking at urine culture sensitivities for discharged patients). Having become increasingly aware of the potential for interruptions during a busy shift to wreak havoc with “door-to-doctor time” and “length-of-stay” statistics, I am seeking new ways to stay focused on minimizing “task stacking,” and actually to finishing something I start. Our CEO was witnessed recently sitting in the ED waiting area with a stopwatch. No joke!

So when the radio or phone goes off and the nurse or secretary calls out, “Medic command!” (my Pavlov's bell), I am rarely actually interrupting my current task for any logical reason. Most prehospital arrivals at my shop are, in effect, primarily horizontal rides to the hospital. The vanishing minority of calls that are true medical emergencies are almost all protocol-driven (e.g., hypoglycemia, chest pain, respiratory distress, seizure activity, hemorrhage, stroke), so why am I even being asked to give command?

And if the medics are only calling to notify our ED of an imminent arrival, why can't the secretary or nurse answer the call and make a bed available?

Drs. Michael Callaham and Brian Bledsoe have been strident and eloquent iconoclasts on the mythology of the EMS system and its protocols.

Lights and sirens, MAST trousers, helicopters, most cardiac medications, home AEDs, merit-badge courses, and even ambulance transport itself are of little or no benefit. What's up with medic command?

David M. Lemonick, MD

Pittsburgh, PA