Introduction and Conditions of Use

Alberta Shock Trauma Air Rescue Society

Alberta Shock Trauma Air Rescue Service Foundation

STARS Aviation Canada Inc.

(collectively "STARS")

 

Conditions of use

Access and use of these Medical Control Guidelines and/or the information contained therein (collectively the "MCG") is provided on the condition that you accept the following terms, and by accessing or using the MCG, you agree to such terms.  If you do not agree to accept and abide by these terms you may not access or use the MCG.

THE MCG IS INTENDED FOR THE ASSISTANCE OF STARS PERSONNEL.  ANY USE BY PERSONS OTHER THAN STARS PERSONNEL ("OTHER USERS") IS SUBJECT TO THE FOLLOWING LIMITATIONS OF LIABILITY.  THE MCG IS INTENDED Solely As A Reference Tool for Practicing, Experienced Healthcare Personnel AND IS PROVIDED ON AN “AS IS” BASIS.  WHILE THE PROVIDERS OF THE MCG (THE "PROVIDERS") HAVE ENDEAVORED TO ENSURE THE ACCURACY, ADEQUACY AND COMPLETENESS OF THE MCG, THE MCG IS SUBJECT TO ONGOING UPDATES AND REVISION.  AS SUCH, THE PROVIDERS EXPRESSLY DISCLAIM ANY AND ALL REPRESENTATIONS, WARRANTIES AND CONDITIONS CONCERNING THE MCG, INCLUDING ANY IMPLIED WARRANTIES, REPRESENTATIONS OR CONDITIONS OF MERCHANTABILITY AND FITNESS FOR A PARTICULAR PURPOSE OR WARRANTIES, REPRESENTATIONS OR CONDITIONS AS TO ANY RESULTS TO BE OBTAINED FROM THE USE OF, OR DERIVED FROM, THE MCG.

NO RESPONSIBILITY IS ASSUMED FOR ERRORS OR OMISSIONS CONTAINED IN THE MCG, or ANY LIABILITY FOR LOSS, DAMAGE OR INJURY WHICH MAY RESULT FROM THE USE OR RELIANCE THEREON.  FOR GREATER CERTAINTY, THE PROVIDERS SHALL NOT, REGARDLESS OF THE THEORY OF LIABILITY, BE LIABLE FOR any loss, DAMAGE OR INJURY (in contract, tort, warranty or otherwise) incurred in connection with (i) THE ACCESS, use or reliance on the MCG; OR (ii) any decision made OR action or inaction taken by any OTHER USER in reliance upon the MCG.

IN ADDITION, Under no circumstances will THE PROVIDERS be liable for any ordinary, direct, indirect, consequential, incidental, special, punitive or exemplary damages arising out of any of the foregoing, WHETHER OR NOT THE PROVIDERS WERE TOLD OF, KNEW OR OUGHT REASONABLY TO HAVE KNOW OF THE POSSIBILITY OF SUCH LOSS, DAMAGE OR INJURY.

Copyright Alberta Shock Trauma Air Rescue Society 2005

STARS’ MEDICAL CONTROL GUIDELINES – DEFINITION AND PURPOSE

The Air Medical Physician Association believes that all air medical transports require physician medical control and that the responsibility for assuring appropriate medical control rests with the Medical Director(s) of the air medical service.  The Medical Director has the final authority over all patient care aspects of the air medical service, which includes medical control for all transports.  The Medical Director may however delegate the responsibility and authority for medical control to other qualified individuals (AMPA Manual 2001) (i.e. Referral Emergency Physician (REP) or, at times, the sending physician).

 

‘EMS necessarily involves the practice of medicine in the prehospital setting, and because only physicians are licensed to practice medicine, active physician participation in EMS is mandatory’ (Alberta Heath and Wellness, Medical Control Guidelines, March 2002).  According to the American College of Emergency Physicians, in the absence of direct medical control, off-line medical direction is the ‘administrative promulgation and enforcement of accepted standards of prehospital care’.  Medical Control Guidelines (MCGs) define the standards of prehospital care and are written to ensure consistency among providers when initiating initial emergency treatment as well as ongoing emergency care.

 

In the absence of an REP (Referral Emergency Physician) in direct attendance, the purpose of these Medical Control Guidelines is to specify, in terms of written performance guidelines, standardized systems of emergency medical care delivery for specific pre-hospital situations and patient presentations, and to manage and standardize steps for patient-related care and transportation.  These Medical Control Guidelines will cover any pre-hospital emergency medical care delivery within the scope of STARS Air Medical Crews.

 

These Medical Control Guidelines are deliberately drafted in flexible form.  No attempt will be made to dictate or confine emergency treatment or to remove the element of field judgment necessary in each specific emergency circumstance.

 

These Medical Control Guidelines carry the authority of STARS’ Medical Director or designate(s), in their capacity as licensed physicians in the Province of Alberta.  They are intended to provide medical control, as defined in the Emergency Medical Technicians Regulation of the Alberta Health Disciplines Act.

 

This Medical Control Guidelines Manual will be continually reviewed, edited and updated as deemed necessary by the Medical Director.

 

These Medical Control Guidelines provide the following:

 

  • written outlines of consistent, systematic patient assessment and management in the field
  • written standards of care for evaluating and improving STARS field medicine
  • coordinated and standardized pre-hospital emergency medical care within the scope of STARS, with physician input, direction and control
  • educational tools for the Air Medical Crew
  • improved continuity and quality of patient care, throughout the delivery system

 

STARS’ MEDICAL CONTROL GUIDELINES – HOW TO USE THEM

STARS Air Medical Crew (AMC) consists of a Paramedic, a Registered Nurse, and at times, a Referral Emergency Physician (REP).  On missions where a REP is present, the physician will be the Medical Authority.  REP orders supercede Medical Control Guidelines, whether or not the REP is in direct attendance or providing on-line medical control.

On scene call missions when an REP is not present, these Medical Control Guidelines will serve as treatment guidelines for the Paramedic and Nurse.  As there are no absolutes in medicine, these Medical Control Guidelines will be considered tools to assist the Air Medical Crew's ability to think and act appropriately in an emergency medical circumstance.

 

On interfacility missions without a physician, AMC will contact the REP to review clinical issues and any aspects of patient care which are not addressed by the MCGs.

 

The intent of Medical Control Guidelines is to provide prehospital care providers with written, systematic guidelines referencing standards of care.  At STARS, our interfacility missions involve a continuance of emergency treatment already initiated by the sending physician.  This presents the STARS crew with unique circumstances not always addressed by traditional models of ‘Off-line Medical Control’.  It is the responsibility of the AMC to use a significant degree of judgment in the management of all patients.  AMC must remember that the guidelines in this manual are not sequential in all cases and that several algorithms may be involved in treating a patient.  In the absence of direct medical control, AMC should attempt to sequentially follow the guidelines; however, in situations where the clinical situation does not fit the guidelines, judgment is allowed and expected.

 

MEDICAL DIRECTORS

Medical Directors are individuals or designates who have entered into an agreement with STARS to provide the service of medical control and direction, in their capacity as licensed Physicians for the pre-hospital medical activities of STARS.  These individuals function as the local medical authority, as defined in the Emergency Medical Technicians Regulation of the Alberta Health Disciplines Act.

 

VARIATION OF MEDICAL CONTROL GUIDELINES

Although it is expected that the MCGs will be followed whenever possible, they are intended to be used as guidelines.  It is impossible to anticipate every situation.  Therefore, it may be reasonable to expect that from time to time there will be intentional variation from the MCGs in order to manage specific cases.  Should a situation arise necessitating a potential variation from the MCGs, AMC will make reasonable efforts to consult with the REP.

 

Any guideline variation should be documented on the patient care report and be justified by supporting documentation.  All such cases are reviewed as part of our quality assurance and management program.

 

In the event of an unintentional variation from guideline(s) or in the event of a treatment error;

  • monitor patients condition closely
  • notify receiving physician as soon as possible
  • inform the Medical Director and the Medical Base Manager as soon as possible
  • complete a written report detailing the circumstances which will be attached to the patient care report.

   

SCENE CALLS

In the interests of rapid response, when STARS is dispatched directly to the scene, the Air Medical Crew shall consist of the Flight Nurse and the Flight Paramedic.

 

INTERFACILITY TRANSPORTS - TRANSFER OF MEDICAL RESPONSIBILITY

During interfacility transfers when the crew is ordered to initiate or continue treatment under the direction of the sending physician that is normally outside of the MCGs, the following should occur:

 

Until a formal transfer of care has occurred such that the patient is solely under the care of our AMC, the orders of the sending physician, as the highest local medical authority, supersede our MCGs.  That being said, if reasonable practice, experience, and common sense raise concerns with AMC with respect to these orders, then the REP should be contacted as soon as possible.  It is preferable that the REP and sending physician discuss any perceived differences in treatment plans in order to come to a consensus.  AMC should then be made fully aware of the agreed upon treatment plan prior to carrying on with therapy.

 

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