0071643192.pdf

EMS AND DISASTER MEDICINE^900

An impaired patient cannot

refuse prehospital care.

Direct medical control =

providing direction to EMTs

during actual patient care.

Patient Transport

■ Refusal of care: The main litigation against EMS, lawsuits number approx-

imately 1 per 24,000 calls.

■ Impaired patient cannot refuse.

■ Competent patient may sign waiver form with online medical physi-

cian consultation.

■ On-scene physician: Can assist with EMS protocols after identity check

■ If on-scene physician assumes full medicolegal responsibility then he

may take control, but must follow patient to hospital.

Public Education

Includes public safety initiatives such as household poisoning prevention and

child car seats

Review and Evaluation

The EMS medical director is a physician who provides administrative and

medical oversight for an EMS system.

Means of medical control and evaluation:

■ Direct medical control and evaluation

■ In-field observation

■ Online medical orders

■ Indirect medical control and evaluation

■ Prospectivevia development of standing orders, medical care proto-

cols, and training

■ Retrospectivevia review of ambulance runs, quality assurance through

EMS training

Denver EMS gets a call that there was an explosion at Mile High Stadium,

with an unknown number of injured victims. Source of the explosion is

unclear. Backup is en route. What would define this event as a medical

disaster?

This event would be defined as a disaster if the local health care system is

unable to meet the needs of the event. It is not determined by the absolute

number of victims or type of event (eg, man-made explosive).

DISASTER

A medical disaster is defined as an event that overwhelms the response capa-

bilities of the community.

■ Itis notdefined by the absolute number of victims or type of event (natural

or man-made).

■ Itisdefined by the health care system’s ability to meet the needs of the event.

With most disasters, patients generally arrive to the ED over a short period of

time with the majority having only minor injuries, not requiring advanced

trauma services.