EMS calls you for assistance regarding a 42-year-old woman with Hodgkin lymphoma who is hypotensive and displaying rapid, shallow respirations.

EMS calls you for assistance regarding a 42-year-old woman with Hodgkin lymphoma who is hypotensive and displaying rapid, shallow respirations. They are calling from the oncologist’s office and he has ordered the EMS personnel to administer IV fluids with dextrose and 3 ampules of sodium bicarbonate because he thinks the patient has severe acidosis from tumor lysis syndrome. The oncologist wants this done en route to the ED as he cannot accompany EMS to the hospital because he has other patients to see in his clinic. This is a deviation from the EMS standard of care protocol; hence they call you as the online medical oversight physician for instruction. What is the most appropriate instruction to give EMS in this situation?

a. They cannot deviate from their prehospital protocols. Tell them to give normal saline and proceed with transfer.

b. The oncologist cannot assume care for the patient without accompanying EMS to the hospital.

c. Although the oncologist cannot accompany EMS to the hospital as the online medical oversight physician, you may authorize EMS to deviate from their prehospital protocols if doing so is in the patient’s best interest.

d. Once EMS arrives and begins treatment on the patient, they have established a relationship with the patient and the oncologist’s orders cannot supersede prehospital protocols.

e. As the physician on-scene, the oncologist’s clinical evaluation and orders supersede both EMS and the online medical oversight physician and EMS is obligated to abide by his orders.

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