scholarly journals Remote certification of out-of-hospital deaths in a Canadian Province: An 8-year experience of a novel practice

2021 ◽  
Vol 9 ◽  
pp. 205031212110011
Author(s):  
Alain Tanguay ◽  
Johann Lebon ◽  
Denise Hébert
Keyword(s):  
Emergency Medical Services ◽  
Medical Services ◽  
Certification Program ◽  
Death Certification ◽  
Rural Regions ◽  
Control Center ◽  
Funeral Home ◽  
Medical Control ◽  
Emergency Medical ◽  
Hospital Deaths

Introduction: Certification of out-of-hospital deaths is challenging as physicians are often unavailable at the scene. In these situations, emergency medical services will generally transport the decedent to the nearest hospital. In 2011, a remote death certification program was implemented in the province of Québec, Canada. The program was managed through an online medical control center and enabled death certification by a remote physician. We sought to evaluate the implementation and feasibility of the remote death certification program and to describe the challenges we experienced. Methods: We retrospectively reviewed all remote death certification requests received at the online medical control center between 2011 and 2019. Data were collected from the online medical control center database and records. Feasibility was determined by evaluating the remote death certification rate. Results: Overall, 84.1% of remote death certification requests were realized, producing a total of 9776 death certificates. Male decedents accounted for 61.5% of remote death certification requests and were more likely than females to undergo a coroner’s investigation for cause of death (36.3% vs 20.8%, p = 0.017). Urban/mixed regions had higher rates of achieved remote death certifications (mean 87.3% vs 76.9%, p = 0.033) and putrefied bodies (mean 3.8% vs 2.2%, p = 0.137) compared to rural regions. Among unrealized remote death certification requests, the most common reason was failure of relatives to designate a funeral home (36.8%). Conclusion: Our 8-year experience with the remote death certification program demonstrates that despite facing numerous challenges, this process is feasible and offers a valuable option to manage out-of-hospital deaths. The remote death certification program is spreading in the remaining regions of Québec. Future studies will aim to quantify how much time this process saves for emergency medical services in each region of the province.

The Utilization of Quality Assurance Methods in Emergency Medical Services

1993 ◽  
Vol 8 (2) ◽  
pp. 127-132 ◽  
Author(s):  
Eric A. Davis ◽  
Anthony J. Billitier
Keyword(s):  
Emergency Medicine ◽  
Quality Assurance ◽  
Emergency Medical Services ◽  
Medical Director ◽  
Medical Services ◽  
Residency Programs ◽  
Medical Control ◽  
Emergency Medical ◽  
Emergency Medicine Physician ◽  
Medicine Physician

AbstractObjective:The concept of the necessity of a good quality assurance (QA) plan for emergency medical services (EMS) is well-accepted; guidelines as how best to achieve this and how current systems operate have not been defined. The purpose of this study was to survey EMS systems to discover current methods used to perform medical control and QA and to examine whether the existence of an emergency medicine residency affected these components.Methods:A survey was mailed in 1989 to the major teaching hospitals associated with all of the emergency medicine residency programs (n = 79) and all other hospitals with greater than 350 beds within the 50 largest United States metropolitan areas (n = 172). If no response was received, a second request was sent in 1990. The survey consisted of questions concerning four general EMS-QA categories: 1) general information; 2) prospective; 3) immediate; and 4) retrospective medical control.Results:Completed surveys were received from 78.5% of residency and 50% of non-residency programs. The majority had an emergency medicine physician as medical director (80.1% vs 61.5%, p = .03). While both residency and non-residency hospitals participated in initial public and prehospital personnel education, academic programs were more likely to be involved in continuing medical education (98.2% vs 82.3%, p = .009). On-line (direct) supervision was more likely to be provided by residency institutions (96.4% vs 81.0%, p = .017) which was provided by a physician in 88.3%. Trip sheet review was utilized by 62.0% of non-residency and 75.5% of residency programs responding, and utilized the paramedic coordinator (44.5% vs 46.1%) or medical director (35.7% vs 34.5 %) primarily.Conclusion:This survey characterizes some of the current methods utilized nationwide in EMS-QA programs. Further research is needed to determine the effectiveness of these various methods, and to develop a model program.

The 1989 Loma Prieta Earthquake: Issues in Medical Control

1993 ◽  
Vol 8 (4) ◽  
pp. 291-297 ◽  
Author(s):  
Jorge Palafox ◽  
James E. Pointer ◽  
Julie Martchenke ◽  
Marie Kleinrock ◽  
Janet Michaelis
Keyword(s):  
Emergency Medical Services ◽  
Life Support ◽  
Medical Services ◽  
Loma Prieta Earthquake ◽  
Base Hospital ◽  
Medical Control ◽  
Emergency Medical ◽  
Major Disaster ◽  
On Line ◽  
Loma Prieta

AbstractIntroduction:The role of the base-hospital and on-line medical control in a disaster has not been investigated previously. This study assesses the roles of base-hospitals and the value and feasibility of on-line medical control during the 1989 Loma Prieta earthquake.Methods:The researchers studied five Bay Area counties most affected by the earthquake: San Francisco, Alameda, San Mateo, Santa Clara, and Santa Cruz. Researchers sent questionnaires to all 1,498 registered EMTs and paramedics in these counties; 620 were returned (41.4%). Respondents answered questions about activities performed, contacts with base-hospitals and other agencies, and problems encountered the night of the earthquake. Researchers selected 63 paramedics for in-depth interviews based on their performance of significant advanced life support (ALS) activities performed during the disaster. The coordinators of the 13 base-hospitals (BHCs) in the region also received and returned questionnaires about medical control, base-hospital roles during the disaster, and problems encountered. Researchers interviewed all five county emergency medical services (EMS) agency directors.Results:The surveys of EMS directors, base-hospital coordinators, and paramedics indicate that confusion existed over the status of medical control after the earthquake. There was general agreement among base-hospital coordinators (BHCs) that suspension of medical control is appropriate in a major disaster.Three bases had appropriate equipment to function as back-up dispatch centers. Eight bases had adequate personnel, but only one BHC felt his personnel had adequate training to function in a dispatch capacity. Nine paramedics did not start or continue resuscitation on patients whom they ordinarily would have begun resuscitation.Conclusion:Emergency medical services should suspend medical control immediately following a major disaster and ensure that all prehospital and base personnel are notified. Disrupted communications protocols for prehospital personnel should reflect the skill and knowledge level of paramedics and the need for rapid, advanced practice in a disaster. Disaster planners should consider other roles for base hospitals in major disasters.

Medical control and accountability of emergency medical services (EMS) systems

1979 ◽  
Vol 28 (4) ◽  
pp. 249-262 ◽  
Author(s):  
D.R. Boyd ◽  
S.H. Micik ◽  
C.T. Lambrew ◽  
T.L. Romano
Keyword(s):  
Emergency Medical Services ◽  
Medical Services ◽  
Medical Control ◽  
Emergency Medical

Case Law Involving Base-Station Contact

1995 ◽  
Vol 10 (2) ◽  
pp. 75-80 ◽  
Author(s):  
Carol J. Shanaberger
Keyword(s):  
Emergency Medical Services ◽  
Case Law ◽  
Base Station ◽  
Legal Issues ◽  
Medical Services ◽  
Radio Communications ◽  
Medical Control ◽  
Emergency Medical ◽  
Medical Directors ◽  
Role Delineation

AbstractIntroduction:Although general discussions of legal claims against emergency medical services (EMS) have been published, there is no literature that examines legal claims that specifically have involved base-station contact for direct medical control.Methods:A review of case law through July 1994 was conducted to identify cases that involved radio communications between a prehospital provider and a physician or nurse under the direction of a physician.Results:Only eight cases could be identified. Each case is described in terms of the event, selected pertinent legal issues, and the opinions rendered by the court.Conclusions:These few cases illustrate some important observations that indicate that there will occur an increase in the detail, role delineation, and clarification of the prehospital providers, medical directors, base-station physicians, and others who provide direct medical control to prehospital EMS providers. These findings have important implications for EMS medical directors.

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