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prestwig1 -

If one sends an ambulance out to the home with a health care provider. With online physician interaction. Has the patient "come to the ED?"

Veer V. -

Disclaimer: not a lawer. No - on-line medical control is not generally considered to trigger an EMTALA obligation

prestwig1 -

This is not the typical online medical control. This program appears to be attempting to divert patients from an ED evaluation. In my opinion this is always a bad idea. We as physician act as though that merely coming to the ED requires us to engage in expensive testing. One can determine stability based on a thorough history and physical exam. Why is it better to determine stability in the patients home without testing, but not in the emergency department? The frequent flier issue is often more a function of physician insecurity. The modern physician cannot seem to evaluate a patient without advanced testing. So this program seems to be diverting the same decision process to the patients home. The exact same process can take place in the ED more efficiently. My concern, "70y/o with COPD nocturnal frequent flier. Pt is evaluated appears to be stable and at baseline. The decision is made that he does not require transport to the ED. The next morning he is found dead" Now what??? As a practical matter I would be far more comfortable defending the decision that further evaluation was not required based upon my own history and physical examination. Than upon someone else's.

Veer V. -

Hi prestwig1, thank you for sharing your concerns. The main goal of the program is to navigate patient appropriately - whether to the ED, their PCP, an UCC, or other locations of care. Oftentimes these patients have poor access to healthcare, and plugging them in with physician care is one of the main objectives of the program. It is only in rare circumstances that patients abuse the system enough to become a 'refusal', and even then this occurs with direct physician involvement and oversight. We are not simply local ED docs taking calls from paramedics; we are the Medical Directors for the EMS system, with intimate knowledge of both the paramedic's skills and the patient's medical history - as we have to approve individual patients to even be eligible for refusal. Please feel free to reach out if you have any other questions.

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A Bad Day for the Mediastinum Full episode audio for MD edition 280:12 min - 390 MB - M4AEM:RAP 2018 March Canadian Edition Canadian 23:47 min - 33 MB - MP3EMRAP 2018 March Spanish Edition Español 88:11 min - 35 MB - MP3EM:RAP 2018 March German Edition Deutsche 95:18 min - 131 MB - MP3EM:RAP 2018 March Aussie Edition Australian 25:49 min - 35 MB - MP3EM:RAP 2018 03 March Board Review Answers 97 KB - PDFEM:RAP 2018 03 March Board Review Questions 96 KB - PDFEMRAP 2018 03 March Individual MP3 Files 352 MB - ZIPEMRAP 2018 03 March Individual Summaries 1 MB - ZIPEM:RAP 2018 03 March Written Summary 552 KB - PDF

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6 AMA PRA Category 1 Credits™ certified by CEME (EM:RAP)

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