Medical direction is the delivery of orders to a care provider in the field who needs authorization to perform procedures that lie outside her scope of practice. For example, paramedics can deliver pain management to patients, but only if it falls below a certain dosage. If the patient is still in pain, they need to contact a doctor to receive an authorization to increase the dose or switch to a more powerful medication. Medical direction provides a clear chain of command for accessing orders in the field and protects patients by ensuring that care providers do not exceed their training.
Doctors can provide medical direction in several ways. One is through the form of written communications known as protocols or standing orders. These directions authorize activities in specific settings. A doctor preparing a patient for transport, for example, could include standing orders to allow the nurses on the ambulance to increase the pain medication to keep the patient comfortable. Likewise, a hospital might have a protocol for handling a particular kind of injury that allows paramedics to move forward with a specific treatment as directed in the written orders.
Verbal authorization is another option. When emergency services personnel get to a patient in the field, they start to provide immediate medical intervention to stabilize the patient and radio back to headquarters to provide information so the hospital can prepare if the patient needs transport. They can also radio for medical direction like authorization to use a specific treatment or device. The paramedics and other personnel have the training to provide the treatment, but not the training to independently decide if it is necessary, and they need medical approval to use it.
Ambulance services maintain steady radio communication systems so paramedics can access medical direction at any time, day or night. This reduces delays and ensures that patients get treatments in the field. This is important if the treatment would be lifesaving or could make a significant difference in patient outcome. If a care provider proceeds without medical direction, he can be liable for any injuries and may be subject to discipline even if the patient doesn't experience any problems.
Members of ambulance crews have a protocol they follow for handling patients and requesting medical direction. As paramedics acquire experience and skills, doctors may trust them more in the field, and will be more likely to approve procedures a paramedic recommends or requests. New paramedics may be subject to more questioning to make sure the procedure is appropriate.
