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Letter to the Editor: EMS an EM Mess

doi: 10.1097/01.EEM.0000425855.74142.40
Letter to the Editor


Maybe it's just me, but has anyone wondered about the efficacy and effectiveness of providing on-line medical command to prehospital care providers?

To me, the medic command calls are just one more senseless interruption, (along with signing crutch forms, signing the PA's charts, and looking at urine culture sensitivities for discharged patients). Having become increasingly aware of the potential for interruptions during a busy shift to wreak havoc with “door-to-doctor time” and “length-of-stay” statistics, I am seeking new ways to stay focused on minimizing “task stacking,” and actually to finishing something I start. Our CEO was witnessed recently sitting in the ED waiting area with a stopwatch. No joke!

So when the radio or phone goes off and the nurse or secretary calls out, “Medic command!” (my Pavlov's bell), I am rarely actually interrupting my current task for any logical reason. Most prehospital arrivals at my shop are, in effect, primarily horizontal rides to the hospital. The vanishing minority of calls that are true medical emergencies are almost all protocol-driven (e.g., hypoglycemia, chest pain, respiratory distress, seizure activity, hemorrhage, stroke), so why am I even being asked to give command?

And if the medics are only calling to notify our ED of an imminent arrival, why can't the secretary or nurse answer the call and make a bed available?

Drs. Michael Callaham and Brian Bledsoe have been strident and eloquent iconoclasts on the mythology of the EMS system and its protocols.

Lights and sirens, MAST trousers, helicopters, most cardiac medications, home AEDs, merit-badge courses, and even ambulance transport itself are of little or no benefit. What's up with medic command?

David M. Lemonick, MD

Pittsburgh, PA

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