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August 22, 1986, Vol 256, No. 8 >
ARTICLE | August 22, 1986

Medical Control: Title and subTitle BreakQuality Assurance in Prehospital Care FREE

Brian R. Holroyd, MD; Robert Knopp, MD; Gene Kallsen, MD
[+] Author Affiliations

Reprint requests to Department of Emergency Medicine, Valley Medical Center, 445 S Cedar Ave, Fresno, CA 93702 (Dr Holroyd).


JAMA. 1986;256(8):1027-1031. doi:10.1001/jama.1986.03380080073031
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Article
References

MEDICAL control is a system of physician-directed quality assurance that provides professional and public accountability for medical care provided in the prehospital setting. In an emergency medical services (EMS) system, medical control provides the operational framework and authorization for paramedics and other physician extenders to provide emergency treatment outside the hospital.11 Ultimate responsibility and authority for patient care remain with the physician.1-4 Medical control and quality assurance are viewed by some as bureaucratic restrictions required to appease governmental officials and the public. However, quality assurance should be developed through clear delegation of authority and responsibility for the specific components of medical control to appropriate individuals.

The National Research Councils' Subcommittee on Medical Control in EMS Systems defines three basic functions of medical control: (1) to ensure that field personnel have immediately available expert direction for emergency care, (2) to ensure continuing highquality field performance, and (3) to

REFERENCES

1 +
Boyd DR, Micik SH, Lambrew CT, et al:  Medical control and accountability of emergency medical services (EMS) systems . Vehicular Tech 1979;;28:249-262.
2 +
Subcommittee on Medical Control, Committee on Emergency Medical Services, Assembly on Life Sciences, National Research Council: Medical Control in Emergency Medical Services Systems: Report of the Subcommittee on Medical Control in EMS Systems . Washington, DC, National Academy Press, 1981;.
3 +
McSwain NJ:  Medical control of prehospital care . J Trauma 1984;;24:172.
4 +
Pons P:  Medical control of prehospital care . J Emerg Med 1984;;1:449-450.
5 +
Cal Health and Safety Code § 1797.202.
6 +
Medical Control of Emergency Medical Services: An Overview for Emergency Physicians . Dallas, American College of Emergency Physicians, 1984;.
7 +
American College of Emergency Physicians:  Medical control of prehospital emergency medical services . Ann Emerg Med 1982;;11:387.
8 +
Pointer JE:  The emergency physician and medical control in advanced life support . J Emerg Med 1985;;3:31-35.
9 +
Kallsen G, Merritt-Lindgren M:  An emergency medical services curriculum for emergency medicine residencies . Ann Emerg Med 1984;;13:912-915.
10 +
Stewart RD, Burgman J, Cannon GM, et al:  A computer-assisted quality assurance system for an emergency medical service . Ann Emerg Med 1985;; 14:25-29.
11 +
Canadian Association of Emergency Physicians:  CAEP position paper on medical control of prehospital emergency services . CAEP Rev 1984;; 5:72.
12 +
Stewart RD:  Prehospital care: Education, evaluation and medical control . Top Emerg Med 1980;;1:67-82.
13 +
Briese GL:  Reassessing training levels for prehospital EMS personnel . J Emerg Med 1983;; 1:67-71.
14 +
Emergency Medical Services Guidelines NPS51 . Washington, DC, National Park Service, 1984;.
15 +
McSwain NE Jr:  Medical control: What is it? JACEP 1978;;7:114-116.
16 +
Latessa EM:  Rx for medical control . JEMS 1984;;9:39-41.
17 +
Cooper MA, Ornato JP:  Involving and educating base station physicians in paramedic programs . Ann Emerg Med 1980;;9:524-526.
18 +
Johnston RV:  Dispatch specific medical training . CAEP Rev 1984;;5:42-44.
19 +
Clawson J:  Dispatch priority training strengthening the weak link . JEMS 1981;;6:32-36.
20 +
Lanese RR, Keller GB, Keller MD:  Monitoring EMS dispatcher performance: An approach to improving interaction with the caller . Emerg Med Serv 1984;;2:229-235.
21 +
Slovis CM, Carruth TB, Seitz WJ, et al:  A priority dispatch system for emergency medical services . Ann Emerg Med 1985;;14:1055-1060.
22 +
Gann DS, Trunkey DD, Boyd D, et al: ' Current status of emergency medical services .; J Trauma 1981;;21:196-203.
23 +
Thompson SJ, Schriver JA:  A survey of prehospital care paramedic/physician communication for Multnomah County (Portland), Oregon . J Emerg Med 1985;;1:421-428.
24 +
Cummins RO, Eisenberg MS:  Prehospital cardiopulmonary resuscitation: Is it effective? JAMA 1985;;253:2408-2412.
25 +
Hunt RC, Bass RR, Graham RG, et al:  Standing orders vs. voice control . JEMS 1982;; 7:26-31.
26 +
Stewart RD:  When less is more: Teflon and telemetry in the space age . Ann Emerg Med 1985;;14:982-985.
27 +
Pozen MW, D'Agostino RB, Sytkowski PA, et al:  Effectiveness of a prehospital medical control system: An analysis of the interaction between emergency room physician and paramedic . Circulation 1981;;63:442-447.
28 +
Hitt JM, Sanders AB:  Prehospital care telemetry: How essential? J Emerg Med 1984;;1:417-420.
29 +
Cayten CG, Oler J, Walker K, et al:  The effect of telemetry on urban prehospital cardiac care . Ann Emerg Med 1985;;14:976-981.
30 +
 American College of Emergency Physicians position statement: Control of advanced life support at the scene of medical emergencies . Ann Emerg Med 1984;;13:547-548.
31 +
Riner RM:  Developing medical control in a rural EMS system . Emerg Med Serv 1981;;10:22-28.
32 +
McSwain NE Jr:  Methodology for evaluating prehospital training programs . EMT J 1977;;1:49-53.
33 +
 Quality assurance: Protocol, professionalism and protection . Emerg Med Serv 1985;;14:10-21.
34 +
Soler JM, Montes MF, Egol AB, et al:  The ten-year malpractice experience of a large urban EMS system . Ann Emerg Med 1985;;14:982-985.
35 +
Luterman A, Ramenofsky M, Berryman C, et al:  Evaluation of prehospital emergency medical service (EMS): Defining areas for improvement . J Trauma 1983;;23:702-707.
36 +
Zavada CA:  Quality assurance of the effects of a prehospital data system on patient care . J Am Med Rec Assoc 1982;;53:89-96.
37 +
Siler KF:  Evaluation of emergency ambulance characteristics under several criteria . Health Serv Res 1979;;14:160-176.
38 +
Mayer JD:  Emergency medical service delays, response time and survival . Med Care 1979;;17:818-827.
39 +
Page JO:  Medical-legal considerations in prehospital care . Top Emerg Med 1980;;1:55-59.
40 +
Page JO:  Legal issues in medical control , in National Research Council: Medical Control in Emergency Medical Services Systems . Washington, DC, National Academy Press, 1981;, pp 112-115.
41 +
Haynes BE, Niemann JT:  Letting go: DNR orders in prehospital care . JAMA 1985;;254:532-533.
42 +
Smith JP, Bodai BI:  The urban paramedics scope of practice . JAMA 1985;;253:544-548.
43 +
Sherman MA, Rath GJ, Schofer JL, et al:  Threats to the validity of emergency medical services evaluation . Med Care 1979;;17:127-138.
44 +
Nagel EL:  Improving emergency medical care . N Engl J Med 1980;;302:1416-1417.
45 +
Henry MC, Stapleton ER:  EMT's and medical control . JEMS 1985;;10:32-34.
46 +
Willemain TR:  The status of performance measures for emergency medical services . JACEP 1975;;4:143-151.
47 +
Stults KR, Brown DD, Schug VL, et al:  Prehospital defibrillation performed by emergency medical technicians in rural communities . N Engl J Med 1984;;310:219-231.
48 +
Eisenberg M, Copass MK, Hallstrom AP, et al:  Treatment of out-of-hospital cardiac arrests with rapid defibrillation by emergency medical technicians . N Engl J Med 1980;;302:1379-1383.

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Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature

Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal

1 +
Boyd DR, Micik SH, Lambrew CT, et al:  Medical control and accountability of emergency medical services (EMS) systems . Vehicular Tech 1979;;28:249-262.
2 +
Subcommittee on Medical Control, Committee on Emergency Medical Services, Assembly on Life Sciences, National Research Council: Medical Control in Emergency Medical Services Systems: Report of the Subcommittee on Medical Control in EMS Systems . Washington, DC, National Academy Press, 1981;.
3 +
McSwain NJ:  Medical control of prehospital care . J Trauma 1984;;24:172.
4 +
Pons P:  Medical control of prehospital care . J Emerg Med 1984;;1:449-450.
5 +
Cal Health and Safety Code § 1797.202.
6 +
Medical Control of Emergency Medical Services: An Overview for Emergency Physicians . Dallas, American College of Emergency Physicians, 1984;.
7 +
American College of Emergency Physicians:  Medical control of prehospital emergency medical services . Ann Emerg Med 1982;;11:387.
8 +
Pointer JE:  The emergency physician and medical control in advanced life support . J Emerg Med 1985;;3:31-35.
9 +
Kallsen G, Merritt-Lindgren M:  An emergency medical services curriculum for emergency medicine residencies . Ann Emerg Med 1984;;13:912-915.
10 +
Stewart RD, Burgman J, Cannon GM, et al:  A computer-assisted quality assurance system for an emergency medical service . Ann Emerg Med 1985;; 14:25-29.
11 +
Canadian Association of Emergency Physicians:  CAEP position paper on medical control of prehospital emergency services . CAEP Rev 1984;; 5:72.
12 +
Stewart RD:  Prehospital care: Education, evaluation and medical control . Top Emerg Med 1980;;1:67-82.
13 +
Briese GL:  Reassessing training levels for prehospital EMS personnel . J Emerg Med 1983;; 1:67-71.
14 +
Emergency Medical Services Guidelines NPS51 . Washington, DC, National Park Service, 1984;.
15 +
McSwain NE Jr:  Medical control: What is it? JACEP 1978;;7:114-116.
16 +
Latessa EM:  Rx for medical control . JEMS 1984;;9:39-41.
17 +
Cooper MA, Ornato JP:  Involving and educating base station physicians in paramedic programs . Ann Emerg Med 1980;;9:524-526.
18 +
Johnston RV:  Dispatch specific medical training . CAEP Rev 1984;;5:42-44.
19 +
Clawson J:  Dispatch priority training strengthening the weak link . JEMS 1981;;6:32-36.
20 +
Lanese RR, Keller GB, Keller MD:  Monitoring EMS dispatcher performance: An approach to improving interaction with the caller . Emerg Med Serv 1984;;2:229-235.
21 +
Slovis CM, Carruth TB, Seitz WJ, et al:  A priority dispatch system for emergency medical services . Ann Emerg Med 1985;;14:1055-1060.
22 +
Gann DS, Trunkey DD, Boyd D, et al: ' Current status of emergency medical services .; J Trauma 1981;;21:196-203.
23 +
Thompson SJ, Schriver JA:  A survey of prehospital care paramedic/physician communication for Multnomah County (Portland), Oregon . J Emerg Med 1985;;1:421-428.
24 +
Cummins RO, Eisenberg MS:  Prehospital cardiopulmonary resuscitation: Is it effective? JAMA 1985;;253:2408-2412.
25 +
Hunt RC, Bass RR, Graham RG, et al:  Standing orders vs. voice control . JEMS 1982;; 7:26-31.
26 +
Stewart RD:  When less is more: Teflon and telemetry in the space age . Ann Emerg Med 1985;;14:982-985.
27 +
Pozen MW, D'Agostino RB, Sytkowski PA, et al:  Effectiveness of a prehospital medical control system: An analysis of the interaction between emergency room physician and paramedic . Circulation 1981;;63:442-447.
28 +
Hitt JM, Sanders AB:  Prehospital care telemetry: How essential? J Emerg Med 1984;;1:417-420.
29 +
Cayten CG, Oler J, Walker K, et al:  The effect of telemetry on urban prehospital cardiac care . Ann Emerg Med 1985;;14:976-981.
30 +
 American College of Emergency Physicians position statement: Control of advanced life support at the scene of medical emergencies . Ann Emerg Med 1984;;13:547-548.
31 +
Riner RM:  Developing medical control in a rural EMS system . Emerg Med Serv 1981;;10:22-28.
32 +
McSwain NE Jr:  Methodology for evaluating prehospital training programs . EMT J 1977;;1:49-53.
33 +
 Quality assurance: Protocol, professionalism and protection . Emerg Med Serv 1985;;14:10-21.
34 +
Soler JM, Montes MF, Egol AB, et al:  The ten-year malpractice experience of a large urban EMS system . Ann Emerg Med 1985;;14:982-985.
35 +
Luterman A, Ramenofsky M, Berryman C, et al:  Evaluation of prehospital emergency medical service (EMS): Defining areas for improvement . J Trauma 1983;;23:702-707.
36 +
Zavada CA:  Quality assurance of the effects of a prehospital data system on patient care . J Am Med Rec Assoc 1982;;53:89-96.
37 +
Siler KF:  Evaluation of emergency ambulance characteristics under several criteria . Health Serv Res 1979;;14:160-176.
38 +
Mayer JD:  Emergency medical service delays, response time and survival . Med Care 1979;;17:818-827.
39 +
Page JO:  Medical-legal considerations in prehospital care . Top Emerg Med 1980;;1:55-59.
40 +
Page JO:  Legal issues in medical control , in National Research Council: Medical Control in Emergency Medical Services Systems . Washington, DC, National Academy Press, 1981;, pp 112-115.
41 +
Haynes BE, Niemann JT:  Letting go: DNR orders in prehospital care . JAMA 1985;;254:532-533.
42 +
Smith JP, Bodai BI:  The urban paramedics scope of practice . JAMA 1985;;253:544-548.
43 +
Sherman MA, Rath GJ, Schofer JL, et al:  Threats to the validity of emergency medical services evaluation . Med Care 1979;;17:127-138.
44 +
Nagel EL:  Improving emergency medical care . N Engl J Med 1980;;302:1416-1417.
45 +
Henry MC, Stapleton ER:  EMT's and medical control . JEMS 1985;;10:32-34.
46 +
Willemain TR:  The status of performance measures for emergency medical services . JACEP 1975;;4:143-151.
47 +
Stults KR, Brown DD, Schug VL, et al:  Prehospital defibrillation performed by emergency medical technicians in rural communities . N Engl J Med 1984;;310:219-231.
48 +
Eisenberg M, Copass MK, Hallstrom AP, et al:  Treatment of out-of-hospital cardiac arrests with rapid defibrillation by emergency medical technicians . N Engl J Med 1980;;302:1379-1383.

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