Mandatory Online Medical Consultation Criteria

Study Notes

Patients who have a history of significant submersion injury require OLMC
Recent, partial or complete foreign body airway obstruction necessitates OLMC
Apparent life-threatening event (ALTE) or brief resolved unexplained event (BRUE) in a neonate or child less than 2 years of age requires OLMC
Patients who refuse care and or transport after a Practitioner administers a medication require OLMC
Ideally, OLMC call should occur prior to medication administration and document the rationale in the PCR

Chest pain is a high-risk criterion
Shortness of breath is a high-risk criterion
Abdominal pain is a high-risk criterion
Abnormal 12-lead ECG is a high-risk criterion
Trauma (meeting anatomical, physiological, or additional criteria) is a high-risk criterion
Headache is a high-risk criterion
Fever greater than 38°C is a high-risk criterion
History of fever within the last 24 hours is a high-risk criterion
Altered vital signs, including:
- Heart rate less than 50 or greater than 115
- Respiratory rate less than 8 or greater than 25
- Systolic blood pressure less than 100 or greater than 180 mmHg
- SpO2 less than 90% (on RA or regular home O2) at rest or during road test
- BGL greater than 18
- Temperature greater than 38°C
Pediatric patients are considered high-risk
Patients greater than 70 years of age are considered high-risk
Pregnant patients are considered high-risk
Drug or alcohol intoxication is a high-risk criterion
Recent in-hospital admission for similar clinical concern is a high-risk criterion

Non-conveyance via an ATR algorithm differs from patient refusal in the decision-making process and outcomes.
Patient refusal occurs when a patient with capacity declines transport to an acute care site despite recommendation by EMS paramedics and/or consultants.
In patient refusal, the patient understands and accepts the risks associated with not being transported.
This patient population is at higher risk for adverse outcomes.

ATR process involves shared decision making among paramedics, healthcare providers, patients, and their support systems (family, alternate decision makers).
The goal of ATR is to identify patients who are low risk for medical deterioration and can have their health needs met without ambulance transport.
ATR aims to keep patients on site, avoiding unnecessary transport to acute care sites.

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