The clinical consult conundrum

Ashley Fillmore provides a framework for consulting with superiors or specialists

March 21, 2022 10:28 AM •

Screen Shot 2022-03-21 at 9.28.37 AM.png

Across EMS (and emergency medicine for that matter), systems are often structured to require consultation with superiors or specialists. Countless hours are spent studying and learning when these discussions are warranted, but little, if any, time is spent on how to make a consult. Ashley Fillmore, a district chief here at MCHD, has worked diligently on streamlining our consult process and she joins the MCHD Paramedic Podcast to help create a consult framework.

Fillmore covers consultations regarding DSI (specifically paralytic/rocuronium use), difficult refusals and high-risk refusals, and offers clinical consultation best practices, including:

Don’t rush – wrap neatly with a bow on top
Speak slowly and clearly (it’s always hectic/loud on scene)
Hit the high points and allow for questions
Don’t ramble (nobody cares about their statin dose)
Don’t get defensive

Learn more:

Should I stay, or should I go?

Managing high-risk/difficult refusals with the FEARS mnemonic

MCHD Paramedic Podcast

The MCHD Paramedic Podcast was launched in early 2018 in an effort to provide easily consumable core-content EMS education and insights from prehospital care thought leaders. The Clinical Services Department of The Montgomery County Hospital District EMS service developed the podcast as a tool to better engage and disseminate continuing education to our MCHD medics as well as first responders and EMS professionals nationwide.

Dr. Casey Patrick is the assistant medical director for Montgomery County Hospital District EMS and is a practicing emergency physician in multiple community emergency departments across Greater Houston. His EMS educational focus is on innovative paramedic teaching via the MCHD Paramedic Podcast. Dr. Patrick’s prehospital clinical research involves the investigation of paramedic use of bolus dose intravenous nitroglycerin for acute pulmonary edema and the implementation of lung protective ventilation strategies for intubated EMS patients. Casey and his wife, Alyssa, work and live in Conroe, Texas, and Spokane, Washington. Together they have five children: Mia, Ainsley, Brock, Dean and Will.

Dr. Dickson graduated with honors from the University of Texas Health Science Center San Antonio in 2001 and completed emergency medicine training at Indiana University in 2004. He serves as the EMS medical director at Montgomery County Hospital District EMS and an assistant professor of emergency medicine at Baylor College of Medicine in Houston, Texas. His academic interests include systems of care in stroke and other time-sensitive emergencies, neurologic emergencies and education. He is board certified in emergency medicine in both the U.S. and Australasia, and has subspecialty board certification in EMS medicine. He has authored multiple professional articles and presented at regional, national and international conferences on emergency medicine and EMS topics.