TY - JOUR
T1 - Comparison of Interventions in Prehospital Care by Standing Orders Versus Interventions Ordered by Direct [On-Line] Medical Command
AU - Holliman, C. James
AU - Wuerz, Richard C.
AU - Miguel de, Gaspar Vazquez
AU - Meador, Steven A.
PY - 1994/12
Y1 - 1994/12
N2 - Objective: The aim of this study was to compare the patient care measures provided by paramedics according to standing orders versus measures ordered by direct [on-line] medical command in order to determine the types and frequency of medical command orders. Design: Prospective identification of patient care measures done as part of a prehospital quality assurance program. Setting: An urban paramedic service in the northeast United States with direct medical command from three local hospitals. Participants: One thousand eight paramedic reports from October 1992 through March 1993. Interventions: All patient care interventions recorded as done by standing orders or by direct medical command orders. Errors in patient care were determined by the same criteria as in the Prior two studies of the same system. Results: Direct medical command gave orders in 143/1,008 (14.2%) cases. Paramedics performed 2,453/2,624 (93.5%) of the total patient care interventions using standing orders. In 61 cases (6.1%), medical command ordered a potentially beneficial intervention not specified by standing orders or not done by the paramedic. 21/171 (12.3%) command orders were for additional doses of epinephrine or atropine in cardiac arrest cases (where the initial doses had been given under standing orders), and 59/171 (34.5%) were for interventions already mandated or permitted by standing orders. The paramedic error rate was 0.6%, and the medical command error rate was 1.8% (unchanged form the prior study of the same standing-orders system). Conclusion: Direct medical command gave orders in 14% of cases in this standing-orders system, but 35% of command orders only reiterated the standing orders. More selective and reduced uses of on-line command could be done in this system with no change in the types or numbers of patient care interventions performed. Prehospital and Disaster Medicine 1994;9(4):202-209.
AB - Objective: The aim of this study was to compare the patient care measures provided by paramedics according to standing orders versus measures ordered by direct [on-line] medical command in order to determine the types and frequency of medical command orders. Design: Prospective identification of patient care measures done as part of a prehospital quality assurance program. Setting: An urban paramedic service in the northeast United States with direct medical command from three local hospitals. Participants: One thousand eight paramedic reports from October 1992 through March 1993. Interventions: All patient care interventions recorded as done by standing orders or by direct medical command orders. Errors in patient care were determined by the same criteria as in the Prior two studies of the same system. Results: Direct medical command gave orders in 143/1,008 (14.2%) cases. Paramedics performed 2,453/2,624 (93.5%) of the total patient care interventions using standing orders. In 61 cases (6.1%), medical command ordered a potentially beneficial intervention not specified by standing orders or not done by the paramedic. 21/171 (12.3%) command orders were for additional doses of epinephrine or atropine in cardiac arrest cases (where the initial doses had been given under standing orders), and 59/171 (34.5%) were for interventions already mandated or permitted by standing orders. The paramedic error rate was 0.6%, and the medical command error rate was 1.8% (unchanged form the prior study of the same standing-orders system). Conclusion: Direct medical command gave orders in 14% of cases in this standing-orders system, but 35% of command orders only reiterated the standing orders. More selective and reduced uses of on-line command could be done in this system with no change in the types or numbers of patient care interventions performed. Prehospital and Disaster Medicine 1994;9(4):202-209.
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U2 - 10.1017/S1049023X00041406
DO - 10.1017/S1049023X00041406
M3 - Article
C2 - 10155529
AN - SCOPUS:0028524741
SN - 1049-023X
VL - 9
SP - 202
EP - 209
JO - Prehospital and Disaster Medicine
JF - Prehospital and Disaster Medicine
IS - 4
ER -