UTSW/BioTel Policy: Physician Coordination at the Scene of a Medical Emergency

Purpose:  The purpose of this policy is to guide UTSW/BioTel paramedics when encountering a physician at the scene of a medical emergency.

  1. GENERAL GUIDELINES:
    1. In general, paramedics shall not accept direction from any physician or members of the public on emergency calls. Only BioTel staff and BioTel medical command physicians are authorized to provide medical direction to paramedics. However, in certain circumstances, a field physician may be authorized to provide medical direction to paramedics if the following conditions are met:
      1. The physician is licensed in the State of Texas, is present on scene and wishes to direct patient care AND agrees to accompany the patient to the hospital; and
      2. The direction being offered by the physician is within the Paramedic Scope of Practice.
      3. A BioTel Medical Command Physician has been contacted and agrees that such direction is appropriate and approves the on-scene physician to direct the care of the patient.
  2. PROCEDURE FOR INTERACTING WITH PHYSICIANS ON-SCENE AT AN EMERGENCY MEDICAL CALL:

PRIOR to accepting direction from an on-scene physician, paramedics shall:

    1. Verify the identity and credentials of the on-scene physician. The physician must produce a current Texas medical license, and must show it to the Paramedic, along with a valid government-issued photo ID demonstrating that he/she is the person whose name is on the medical license;
    2. Advise the physician that he or she will be required to ride in the ambulance with the patient to the hospital and must sign the Prehospital Care Record;
    3. Contact BioTel and seek approval from the Medical Command Physician allowing the on-scene physician to direct the care of the patient.
  1. ON-SCENE PHYSICIAN OPTIONS:

Once the on-scene physician has provided his/her medical license and official governmental ID, paramedics shall contact BioTel and inform staff that a physician on scene is requesting to provide medical direction.  BioTel staff shall inform the on-duty Medical Command Physician who will discuss the on-scene physician’s offer to direct the care of the patient with the paramedics and then with the on-scene physician.  Following these conversations, and with the approval of the BioTel Medical Command Physician:

    1. The on-scene physician may assist the paramedics and offer advice regarding patient care, but must allow the paramedics to remain in control of the scene and to treat/transport the patient according to BioTel policies and Guidelines For Therapy;

      -OR-

    2. The on-scene physician may be given approval by the BioTel Medical Command Physician to direct the care of the patient within the paramedics’ scope of practice. The on-scene physician must accompany the patient in the ambulance to the hospital, and must assume total responsibility for the patient’s care until emergency department staff assumes this responsibility. The paramedics will assist the physician as requested, provided that they operate within the standard of care and the paramedic Scope of Practice. All orders given by the on-scene physician shall be documented on the ePCR and the physician shall sign the ePCR. Finally, the physician’s name, medical license number and complete contact information will be documented on the ePCR.
  1. SPECIAL CIRCUMSTANCES:
    1. Physicians in a healthcare setting (hospital, clinic or physician’s office):
      1. Physicians already caring for a patient in a hospital or clinic setting have established a physician-patient relationship and therefore do not fall under the requirements of this policy. That being said, should a physician already caring for a patient direct the paramedics to administer a medication or perform a procedure, paramedics shall inform the physician that they operate under the direction and treatment guidelines of the UTSW/BioTel system and can only provide care consistent with the BioTel Guidelines for Therapy. Should the physician still wish to direct the care of the patient, BioTel shall be contacted so that the on-scene physician may speak directly with the BioTel Medical Command Physician.
      2. In general, decisions made by such physicians regarding whether to transport a patient by ambulance, as well as the destination hospital for a patient, shall be respected, assuming that the hospital is a BioTel receiving hospital and paramedics believe that the destination hospital can appropriately care for that patient. Of course, the patient must consent to the transfer. If there is a discrepancy between the physicians’ direction to transport the patient by ambulance OR the physicians’ direction regarding the appropriate destination hospital, BioTel shall be consulted and an EMS supervisor shall be requested to respond to the scene.
      3. Paramedics shall always maintain a professional and respectful demeanor, as they do with any member of the public when interacting with a physician at the scene of a medical emergency.
    1. Do Not Resuscitate (DNR) Orders:
      1. An on-scene physician who has been identified as the patient's personal physician may issue a DNR Order, which Emergency Medical Services (EMS) personnel may follow, if the physician has been properly identified and states that he or she is accepting full medical-legal accountability; family members, if present, must agree. This order shall be documented on the ePCR and must be approved by the BioTel Medical Command Physician. In this circumstance, the Medical Command Physician may waive the requirement for the physician to accompany the patient during ambulance transport, should transport to a receiving hospital ensue.
      2. If there is ANY question or concern regarding the appropriateness of the on-scene physician issuing a DNR Order, paramedics shall begin resuscitation according to BioTel Guidelines for Therapy, as indicated, while contacting BioTel for further direction.
    2. EMS Physicians:
      1. On occasion, paramedics will encounter a physician who is trained and experienced in working with prehospital care providers. Such “EMS Physicians” may or may not be known to paramedics.
      2. If a physician identifies him/herself as an “EMS Physician” and is known to the paramedics, they may follow the direction of the “EMS Physician” provided such direction is consistent with BioTel Guidelines for Therapy and the paramedics agree that such direction is appropriate for the care of the patient.  If the paramedics disagree with the care suggested by the “EMS Physician”, BioTel shall be immediately contacted and an EMS supervisor shall be requested to respond to the scene. Known “EMS Physicians” are not required to accompany the patient to the hospital in the ambulance, although doing so is acceptable if the paramedics and the “EMS Physician” believe it would be of benefit to the patient.  Any direction provided to the paramedics by the “EMS Physician” shall be documented on the ePCR.
      3. If the “EMS Physician” is NOT known to the paramedics, they shall ask the physician to provide some form of credentials, such as an EMS agency ID card, badge or other appropriate evidence that they function as an EMS Physician. In such cases, paramedics may utilize judgment as to whether to accept advice or direction from such a physician.  If there is any question as to the validity of the physician’s credentials or the medical direction he/she offers, paramedics will inform the physician of the requirements of this policy and act accordingly.
      4. This procedure shall be followed whether the paramedics are evaluating a patient at a single scene or at a public venue such as a concert, marathon race, church service or other “mass gathering” event.
      5. Any questions regarding interactions with “EMS Physicians” on-scene shall be referred to BioTel.
  1. INFORMATION CARD FOR PHYSICIANS SEEKING TO ASSIST PARAMEDICS IN THE FIELD:
    (This is NOT to be shown to physicians already caring for a patient in a healthcare setting).

Information For Physicians Seeking to Assist Paramedics at the Scene of a Medical Emergency:

Thank you for your offer to assist paramedics in caring for a person in need of emergency medical evaluation and treatment in the field.

PLEASE READ THE FOLLOWING INFORMATION CAREFULLY:

In the State of Texas, paramedics operate under the authority and direction of a designated, accountable EMS Medical Director and are only authorized to provide emergency medical treatment utilizing the protocols and guidelines for therapy approved by the Medical Director.  The paramedics on scene are experienced professionals who are experts in providing out-of-hospital emergency medical evaluation and treatment. They operate for the University of Texas Southwestern Medical Center (UTSW) BioTel EMS System, led by Medical Director Dr. Paul Pepe. Any physician wishing to assist the paramedics in the care of a patient must:

  1. Provide to the paramedics for verification a copy of his/her current Texas medical license and also an official government-issued photo ID. Once that verification has been completed, the physician may:
  1. Consult with the on-duty BioTel Medical Command Physician and offer advice on the care of the patient, but allow the Medical Command Physician to direct patient care; OR
  2. With the approval of the BioTel Medical Command Physician, he/she may direct the paramedics within the Texas paramedic Scope of Practice and then accompany the patient to the hospital and assume total responsibility for patient care until this responsibility is assumed by emergency department staff.  In this case, the paramedics will assist the physician as requested, provided they operate within the Scope of Practice.  All orders given by the on-scene physician shall be documented on the electronic care record and signed by the physician. The physician’s name, medical license number and contact information will be documented on the electronic care record.

If you do not have a copy of your medical license and a photo ID, or if you are not willing to consult with the BioTel Medical Command Physician, accept in writing full medical-legal accountability for the care rendered AND accompany the paramedics and the patient in the ambulance to the hospital, PLEASE stand back and allow the paramedics to do their job.

Thank you.