12 Questions
What is a mandatory criteria for Online Medical Consultation (OLMC) in a patient who has experienced an apparent life-threatening event?
If the patient has a history of foreign body airway obstruction
When should the Online Medical Consultation (OLMC) call ideally occur?
Prior to medication administration
What is not a high-risk criterion for considering Online Medical Consultation (OLMC)?
Fracture of the arm
In which situation is it considered clinically necessary to consider contacting Online Medical Consultation (OLMC)?
If the patient has any other high-risk criteria
What is a high-risk criterion for considering Online Medical Consultation (OLMC)?
Headache
What is a mandatory criteria for Online Medical Consultation (OLMC) if the patient refuses care and transport after a Practitioner administers a medication?
If the patient refuses care and transport
What is the primary difference between patient refusal and non-conveyance via an ATR algorithm?
The decision-making process involved in determining the need for transport
What is the primary goal of the ATR algorithm in determining patient transport?
To identify patients who are low risk for medical deterioration and can be managed without transport
What is the primary consequence of patient refusal?
The patient is at higher risk for adverse outcomes
What is the role of the healthcare team in the ATR algorithm?
To participate in shared decision making with the patient and their support systems
What is the primary characteristic of the patient population that refuses transport?
They are at high risk for adverse outcomes
What is the primary difference between the ATR algorithm and patient refusal in terms of decision making?
The involvement of the healthcare team in the decision-making process
Study Notes
Mandatory Online Medical Consultation (OLMC) Criteria
- 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
High-Risk Criteria for OLMC
- 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 vs Patient Refusal
- 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.
Alternative to Transport (ATR) Process
- 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.
This quiz covers the criteria for mandatory online medical consultation, including patient history, airway obstruction, and apparent life-threatening events in neonates and children.
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