Hennepin County EMS system

1. Hennepin CountyEMS system Physician Medical Control Training Program

2. 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.

3. 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.

4. 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)

5. 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.

6. 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.

7. 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

8. 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

9. 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.

10. Hennepin County Medical Control Hospitals The Hennepin County system medical control hospitals are: • Abbott Northwestern • Children’s 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 Children’s Hospital

11. 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.

12. 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 hospital’s 800 MHz EMS radio.

13. 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.

14. 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.

15. 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

16. 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

17. 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.

18. 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 paramedic’s Patient Care Report (PCR) to identify you as the physician who provided medical control.

19. 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.

20. 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.

21. 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.

22. 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.

23. 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 patient’s 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).

24. 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.

25. 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.

26. 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.

27. 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.

28. 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.

29. 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.

30. 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 Unit’s website to self-administer the physician medical control exam.

31. 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.

32. 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 ED’s 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 <your medical control certification number> doing a radio check for <your hospital’s name>. • The WMRCC dispatcher will confirm receipt of your transmission. • You have now completed your certification process.

33. 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 (612) 348-6001 • Fax (612) 348-3830 • Question related to medical control: • Hennepin County Human Services and Public Health Department • Phone (612) 348-5423 • Fax (612) 348-3830