Emergency Medical Services (EMS) On-Line Medical Consultants (OLMC)

Background:
 

Since 2009, OLMC physicians have supported frontline paramedics in their efforts to provide high quality, evidence based medical care to their patients. This province-wide rapid access to a dedicated EMS Physician is available 24 hours per day / 7 days per week. Since 2009 there have been many changes to the EMS profession and Paramedic practice.   EMS became a self-regulated profession under the Health Professions Act in 2016, has become progressively integrated with the health care system over the last decade and has developed non-traditional community-based services such as Mobile Integrated Health and Palliative Care Pathways.  OLMC physicians need to have a good understanding not only of EMS Medical Protocols and paramedic scope of practice but are expected to support an increasingly complex EMS system including progressive solutions to patient care including non-conveyance and community referral.

Job Summary:
 

The OLMC physician is an integral member of the EMS system, responsible for providing support to front line paramedics and dispatchers, including in the areas of: clinical management, patient and provider safety, destination determination, system support, high risk patient transport refusals, non-conveyance treat and referral pathways, and patient and physician communication.  OLMC stations are located at EMS Central Communication Center in Edmonton and EMS Southern Communication Center in Calgary.  Our experience is that call taken from one of the Dispatch Centers has positively influenced the quality of consultation and the connection between OLMC physicians and EMS staff.  However, the Program recognizes the importance of physician wellness and OLMC shifts can be taken from home during dark hours, weekends, holidays, illness, or when home call is deemed important to the wellness of the physician.  We know everyone leads busy lives.   The OLMC physician is expected to participate in program quality assessment and improvement initiatives, and in the general evolution of the program.
 

Responsibilities / Accountabilities:
 

• Clinical advice to EMS crews to support decision making regarding issues including but not limited to medical treatment, transport destination, multi-leg patient transports, navigating stroke and ST-Elevation Myocardial Infarction (STEMI) pathways, advanced airway decision making, withholding/discontinuing resuscitation.
• Support paramedics and patients for non-conveyance decisions, including finding alternatives to emergency department EMS transport (i.e., palliative and end-of-life care, referrals to Mobile Integrated Health (MIH), Assess Treat and Refer Pathways, etc.).
• Provide advance notification and advice to rural receiving sites of an incoming sick patient and initiate secondary transport strategies.
• Offer clinical advice to dispatchers to support their decision-making, for example supporting decisions around level of transport required (Advanced Life Support (ALS)/Basic Life Support (BLS)), time sensitivity of interfacility transport (IFT) requests, etc.
• Be familiar with the AHS EMS Medical Control Protocols including Assess, Treat and Refer Protocols;
• Be familiar with EMS Operational and Destination Protocols including the Trauma Destination Tool, Provincial Stroke Strategy, Vital Heart Response, South STEMI Pathway;
• Be familiar with EMR, PCP and ACP scope of practice;
• Be familiar with the various specialty and community based resources within EMS (including Specialized Treatment Protocols and Care Plans, CHAPS, City Centre, MIH coordination center, Community Paramedics, Palliative End of Life Care, etc.);
• Participate in OLMC audit (Debrief and Discuss) and quality improvement initiatives;
• Be familiar with the role of the Transport Physician in Red Patient Interfacility Transport and Referral;
• Support dispatchers with clinical advice that would support their work.  (For example, supporting decisions around level of transport required (ALS/BLS) or time sensitivity of Inter-Facility Transport requests);
• Use Connect Care to support clinical advice and decision making;
• Follow scheduling rules to ensure 24/7 coverage;
• Not provide direct care, “on-call” services, or participate in any additional work opportunities for any other department or program during hours remunerated;
• Support the collection of patient demographic information for the purposes of audit and tracking;
• Participate in additional work activities which are identified by EMS stakeholders as providing value to the EMS system; this may include mentoring Paramedic Specialists, supporting medical resident education, integrating virtual technologies into OLMC practice, etc.
• Engage with paramedics by being a front-line presence through ride-alongs or interacting with staff in the Emergency Department.
• Only use AHS email accounts for all communications.
   

Note that the program has developed orientation materials and an on-boarding strategy to ensure new program participants are prepared for the work.