Hennepin County EMS system

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Hennepin CountyEMS system

• Physician Medical Control Training Program

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Instructions
This training program has a run time of
approximately 26 minutes. Each slide will
progress via automated timers. In the bottom left
corner of each slide are a Back and Forward slide
control button that can be used to move between
slides manually. If you manually go back to
review a previously seen slide or a slide you
missed using the Back button you will need to
manually forward the slideshow using the Forward
button.
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Disclaimer
The Physician Medical Control Training Program is
intended for use only in the Hennepin County EMS
system as an orientation tool to familiarize
physicians, working at an authorized system
medical control hospital, with the process of
providing medical control to paramedics in the
field.
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What topics will be covered by this training

• Importance of medical control
• Foundation for medical control
• Medical control structure overview
• Liability related to medical control
• Medical control process
• 800 MHZ EMS radio operation
• Medical control certification process
• Examples of medical control calls/recordings
• Frequently Asked Questions (FAQ)

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Why Medical Control Exists
Medical Control plays a valuable role in the
Hennepin County EMS system. While paramedics
operate predominantly under standing orders to
treat and care for patients occasionally they may
encounter a specific patient condition, anomaly,
or situation where consultation with a physician
for guidance can help the paramedics decide the
most appropriate course of action for treatment
and transport.
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The Importance of Medical Control
Medical Control allows for specific drugs and/or
procedures, not authorized via standing orders
but available through the ALS medical protocols,
to be administered by paramedics after
consultation with a medical control physician.
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Foundation for Medical Control
The foundation for the Hennepin County EMS system
is Ordinance 9. The ordinance creates the EMS
Council which develops policies and guidelines
for the EMS system. These policies and guidelines
contain reference to medical control.
Ordinance 9, Section III, Subsection 8, part C
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EMS System - Ambulance Services

• The Hennepin County EMS system is comprised of
  five ambulance services operating a Primary
  Service Area (PSA) within the County. They are
• Allina Medical Transportation
• Edina Fire Department
• Hennepin EMS
• North Memorial Ambulance
• Ridgeview Ambulance

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EMS System Medical Control Hospitals
Over a dozen medical control hospitals provide
the backbone for the medical control system
within Hennepin County. These hospitals employ
Emergency Department (ED) physicians who have
been certified through the Health Authority to
provide medical control.
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Hennepin County Medical Control Hospitals
The Hennepin County system medical control
hospitals are

• Abbott Northwestern
• Childrens Hospital of Minneapolis
• Fairview Southdale Hospital
• Hennepin County Medical Center
• Maple Grove Hospital
• Mercy Hospital
• Methodist Hospital
• North Memorial Medical Center

• Ridgeview Medical Center
• St. Francis Medical Center
• Two-Twelve Medical Center
• Unity Hospital
• University of Minnesota Medical Center
• University campus
• Riverside campus
• Amplatz Childrens Hospital

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ALS Medical Protocols
The EMS Council approves the Advanced Life
Support (ALS) medical protocols which provide
uniform guidance and direction to the 500
paramedics operating in Hennepin County.
The ALS medical protocols are continually revised
and published every two years with input from
paramedics, nurses, physicians, hospital
administrators and ambulance medical directors.
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Medical Control Process How it Works
Medical Control may be obtained one of two ways,
via radio or phone. Depending on the
communication process that each ambulance service
uses you should be ready to provide medical
control over the phone or via your hospitals 800
MHz EMS radio.
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Medical Control Process How it Works cont.
Some ambulance services may use a intermediary
such as the Medical Resource Control Center
(MRCC) or their own communications center to
notify your ED that a physician is needed to
provided medical control.
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Liability
Question Once certified to provide medical
control in Hennepin County can I be held liable
for the medical direction I provide when I give
medical control to paramedics? Answer Yes. All
medical control calls are recorded and retained
for one year. These records are discoverable if
legal action should ensue related to the incident.
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800 MHz EMS Radio
Volume Knob Controls the loudness of the received
signal

• Push-to-Talk
• Button on inside of handset
• Press to talk Wait for talk permit tones
  (beep-beep-beep)
• Release and wait if you hear a busy tone
  (b-o-n-k)
• Release to listen
• Simple Operation only one person speaking at a
  time

• Push-to-Talk
• Press red button to talk Wait for talk permit
  tones (beep-beep-beep)
• Release and wait if you hear a busy tone
  (b-o-n-k)
• Release to listen
• Simple Operation only one person speaking at a
  time

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Medical Control Certification Process

• Physicians new to the Hennepin County Medical
  control system must undergo a certification
  process. The process includes
• Completion of this training program
• Completion of the certification exam

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Medical Control Certification Process cont.
Upon completion (with a passing score) of the
exam and required paperwork you will be issued a
medical control certification number. This number
is assigned to you and is unique within the
system. Medical control physicians shall
provide their certification number to paramedics
who contact their hospital requesting medical
control.
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Medical Control Certification Process cont.
Specific details about your Medical Control
certification number Do not lend your number to
another physician for use. This number is unique
to you and is recorded on the paramedics Patient
Care Report (PCR) to identify you as the
physician who provided medical control.
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Audio Recordings of Medical Control
In the following slides you will hear three
examples of medical control conducted over the
800 MHz radio system. On the slides there will be
embedded media that appears as a black box. The
media will launch automatically and you will hear
the audio for the medical control call. While
there is no accompanying video with the audio,
please pay attention to the media box for
teaching points that will intermittently pop up
at points throughout the audio recording.
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Audio Recording of Medical Control
Example 1 Adult Diabetic Emergency This
recording represents an example of a medical
control call for an adult diabetic patient who
has received treatment but does not wish to be
transported to the hospital via ambulance.
Recording will launch automatically.
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Audio Recording of Medical Control

• Summary of Example 1 Adult Diabetic Emergency
• What went right
• The physician provided his medical control
  certification number.
• The physician asked pertinent questions.
• What went wrong
• A complete set of vital signs were not provided
  or asked for.

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Audio Recording of Medical Control
Example 2 Adult Hypotension This recording
represents an example of a medical control call
for an adult patient with end-stage cancer,
difficulty breathing, and hypotension.
Recording will launch automatically.
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Audio Recording of Medical Control

• Summary of Example 2 Adult Hypotension
• What went right
• The physician provided his medical control
  certification number.
• The physicians asked pertinent questions.
• The physician quickly recognized that the
  patient was very ill.
• The physician quickly ascertained that, due to
  the gravity of the patients condition, a
  diversion to a closer hospital was necessary.
• What went wrong
• The time it took for the physician to respond to
  the request for medical control was long (actual
  recording this example was based on was over a
  two minute wait).

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Audio Recording of Medical Control
Example 3 Adult Homicide This recording
represents an example of a medical control call
for an adult patient in traumatic cardiac arrest
secondary to being stabbed.
Recording will launch automatically.
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Audio Recording of Medical Control

• Summary of Example 2 Adult Homicide
• What went right
• The physician provided his medical control
  certification number.
• What went wrong
• The physician failed to recognize that the
  paramedics were unsure what they should do with
  this patient.
• Although the paramedics clearly stated at the
  onset of the call that the patient was in
  Asystole, four minutes into the conversation no
  decision had yet been made to resuscitate the
  patient or not.
• The physician fixated on the specifics of the
  knife.
• Inappropriate comments were made by the
  physician.

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Frequently Asked Questions (FAQ)

• Q. Does my Hennepin County medical control
  certification number have any applicability or
  relevance outside the Hennepin County EMS system?
• No. Your system medical control certification
  number is relevant only within the Hennepin
  County EMS system.

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Frequently Asked Questions (FAQ)

• Q. If I stop and/or render aid at the scene of an
  emergency in Hennepin County are there any system
  policies or guidelines that define my authority?
• Yes. Please see the Hennepin County ALS
  Protocols, General Guidelines Physician Presence
  at the Scene of an Emergency guideline.

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Frequently Asked Questions (FAQ)

• Q. Should I give my medical control number to the
  paramedic on the phone/radio?
• Yes. If you do not provide this information when
  you initially answer the call you should provide
  it sometime before the end of the transmission.
  It is your responsibility to include your medical
  control number in the recording that is being
  made, even if the paramedic does not specifically
  ask for it.

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Frequently Asked Questions (FAQ)
Q. If I am issued a physician medical control
number, then leave the system medical control
hospital I am certified at for employment at
another system medical control hospital, do I
continue to use the same certification number? A.
No. You will be issued a new certification number
that coincides with the assigned number series
for the new hospital where you will be working.
If you are employed at more than one hospital you
will be assigned a number for the hospital where
you work most of your hours.
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Frequently Asked Questions (FAQ)
Q. I have completed this training program, what
should I do now? A. After completion of this
training program you should obtain the necessary
paperwork from the Health Authority EMS Units
website to self-administer the physician medical
control exam.
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Frequently Asked Questions (FAQ)
Q. I completed the exam and faxed it in to the
Health Authority, what now? A. Your exam will be
graded and you should be contacted by staff from
the Health Authority with your results. If you
have passed the exam you will be assigned a
medical control number.
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Frequently Asked Questions (FAQ)

• Q. I passed the exam and received my medical
  control certification number, is there anything
  else I need to do?
• The final step in your certification process is
  to do a radio check with the West MRCC over your
  hospital EDs 800 MHz EMS radio.
• Call the West MRCC at 612-347-2123
• Tell them you are a newly certified medical
  control physician and would like to do a radio
  check.
• The West MRCC Dispatcher will direct you to your
  radio and ask you to press the Push-To-Talk (PTT)
  button to do your radio check. Press and hold the
  PTT button and state this is ltyour medical
  control certification numbergt doing a radio check
  for ltyour hospitals namegt.
• The WMRCC dispatcher will confirm receipt of your
  transmission.
• You have now completed your certification
  process.

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Contact Information
If you have any medical control related
questions, please contact

• Question related to the examination process
• Hennepin County Human Services and Public Health
  Department
• Phone [phone]
• Fax [phone]
• Question related to medical control
• Hennepin County Human Services and Public Health
  Department
• Phone [phone]
• Fax [phone]