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Online medical direction mostly for refusals

Patterns of Online Medical Direction Utilization in an Urban EMS System: A Retrospective Analysis of 9,944 Consultations
Prehospital Emergency Care · Added 18 August 2026

Retrospective analysis of 9,944 online medical direction consultations from 2016-2024 found OLMD is primarily used for patient refusals (65%) with 97% physician approval, and overall ~93% agreement between paramedic requests and physician decisions

Study type

Cohort

Design

Retrospective descriptive analysis of consultation records

Participants

9,944 online medical direction consultations (2016-2024)

Main finding

Patient refusals accounted for 65% (n=5,175) of consultations with 97% physician approval; termination of resuscitation and transport destination requests approved in 98% and 90%; overall physician agreement ~93%

Caveat

Single urban US (border) EMS system, may not generalise to Australian practice

Bottom line

Context only

Learning goal

Understand the system factors that shape when paramedics seek online medical direction for patient refusals and capacity decisions.

More

• Topic: Operations & systems
• Daily scan: 18 August 2026

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