NORTH COAST EMERGENCY MEDICAL SERVICES Policy # 2302

POLICIES AND PROCEDURES

Subject: Medical Control

Cancellation and Transfer of Patient Care Policy

I. Authority and Reference (Incorporated Herein By Reference)

A. Title 22, California Code of Regulations, Division 9.

B. Division 2.5 of the Health and Safety Code.

E. All North Coast Emergency Medical Services Policies and Procedures.

II. Purpose

To establish procedural guidelines for basic life support (BLS) personnel

to discontinue response of advanced life support (ALS) or limited

advanced life support (LALS) and provide BLS transport, and guidelines

for LALS personnel to discontinue an ALS response and provide LALS

transport. This policy is also intended to establish a procedure for

pre-hospital care personnel to relinquish care and custody of a patient

to a lower certificate holder.

III. Guidelines For Cancellation of ALS or LALS response by BLS Personnel

A. In general, BLS personnel at the scene of a medical emergency should

not transport if ALS or LALS personnel are responding. Ordinarily,

BLS personnel should wait for ALS or LALS personnel to arrive at the

scene. The following exceptions may be applied:

1. the patient is suffering from an injury or illness which clearly

requires rapid transport in order to reduce the risk of increased

morbidity or mortality caused by delayed transport; or,

2. the patient clearly has only a minor injury or illness which has

no apparent indication for ALS or LALS care.

B. If, in the opinion of BLS personnel, the patient meets one of the

above exceptions for cancellation of ALS or LALS with BLS transport,

then the BLS provider shall contact the base hospital by radio or

telephone with a complete report of the patient's condition. The

base hospital physician or MICN shall determine if cancellation of

ALS or LALS with BLS transport is appropriate.

C. ALS or LALS may be cancelled with base hospital permission for BLS

transport. Transporting BLS units shall attempt to rendezvous with

an ALS or LALS unit between the scene and receiving hospital if so

ordered by the base hospital.

D. In the event of radio failure and or inability to telephone the Base

Hospital, the BLS unit may transport a patient if the patient clearly

meets one of the exception-criteria in paragraph A of this section.

In the event that the patient has any apparent indication for ALS or

LALS, then the transporting BLS unit shall not cancel an ALS or LALS

response; rather, the BLS unit shall attempt to rendezvous with an

ALS or LALS unit between the scene and receiving hospital.

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Subject: Medical Control

Cancellation and Transfer of Patient Care Policy - continued

IV. Guidelines For Cancellation of ALS Response By LALS Personnel

A. LALS personnel at the scene of a medical emergency should not

transport a patient if ALS personnel are responding, and the patient

has indication(s) for pre-hospital ALS treatment exceeding EMT-II

scope of practice. The following exceptions may be applied:

1. the patient is suffering from an injury or illness which clearly

requires rapid transport in order to reduce the risk of increased

morbidity and mortality caused by delayed transport; or,

2. the patient has an injury or illness which does not require EMT-P

treatment (therapy within EMT-P scope of practice that exceeds

EMT-II scope of practice) for the relief of unnecessary

suffering, and/or decreased risk of morbidity and mortality.

B. If, in the opinion of LALS personnel, the patient meets one of the

above exceptions for cancellation of ALS with LALS transport, then

the LALS provider shall contact the base hospital by radio or

telephone with a complete report of the patient's condition. The

base hospital physician or MICN shall determine if cancellation of

ALS with LALS transport is appropriate.

C. ALS may be cancelled with base hospital permission for LALS

transport. Transporting LALS units shall attempt to rendezvous with

an ALS unit between the scene and receiving hospital if so ordered by

the base hospital.

D. In the event of radio failure and/or inability to telephone the base

hospital, the LALS unit may transport a patient if the patient

clearly meets one of the exception-criteria in paragraph A of this

section. In the event that the patient has any apparent indication

for ALS, then the transporting LALS unit shall not cancel an ALS

response; rather, the LALS unit shall attempt to rendezvous with an

ALS unit between the scene and receiving hospital.

V. Relinquishing Patient Care To A Lower Certificate Holder:

A. The following pre-hospital care certificate holders may relinquish

custody and care of a patient to a lower certificate holder when the

patient's condition clearly does not require the scope of practice of

higher certificate holder; that is, the scope of practice of the

lower certificate holder can address the needs of the patient: EMT-P

to EMT-II or EMT-I; EMT-II to EMT-I.

B. If a pre-hospital provider seeks to relinquish care to a lower

certificate holder, he/she shall contact the base hospital with a

complete report of the patient's condition, and specify to whom the

patient will be transferred (EMT-II to EMT-I; EMT-P to EMT-II,

etc.). The base hospital may grant or deny permission for the

same.

C. In the event of radio failure and or inability to telephone the base

hospital, the higher certificate holder shall maintain care and

custody of the patient.

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Subject: Medical Control

Cancellation and Transfer of Patient Care Policy - continued

VI. Documentation and Base Hospital Review:

A. Implementation of this Policy by pre-hospital care personnel

shall be documented on the Ambulance/Rescue Record (ARR). When

applicable, a Radio Failure Report shall also be completed and

submitted with a copy of the ARR in accordance with North Coast EMS

Policy and Procedure.

B. The base hospital should review and discuss implementation of this

Policy during regular chart review, and shall report any problem or

pattern of irregularity in compliance with this Policy to the North

Coast EMS Medical Director.

Approved: Date:

Approved as to Form: Date: