On-Line Medical Direction: A Prospective Study

Objectives: To determine the frequency with which physician, on-line medical direction (OLMD) [direct medical control] of prehospital care results in orders, to describe the nature of these orders, and to measure OLMD time intervals. Methods: Blinded, prospective study.Setting: A university hospital base-station resource center.Participants: Ten emergency physicians, 50 advanced life support providers. Interventions: Prehospital treatment was directed by both standing orders and OLMD physician orders. Independent observers recorded event times and the characteristics of OLMD. Results: Physician orders were given in 47 (19%) of the 245 study cases, and covered a variety of interventions, including many already authorized by standing orders. Mean OLMD radio time was four minutes (245 ±216 seconds [sec]), and time from beginning of OLMD to hospital arrival averaged 12 minutes (718 ±439 sec). Mean transport time in this system was 13 minutes. Conclusion: Despite detailed standing orders, OLMD results in orders for clinical interventions in 19% of cases. On-line medical direction requires about four minutes of physician time per call. This constituted about one-third of the potential field treatment time interval in this system. Thus, OLMD appears to play an important role in providing quality prehospital care. Prehospital and Disaster Medicine, 1995;10(3)174-177.