What is the language for medical directives and inter-facility transfers with escorts? If a patient meets the indications and conditions for a medical directive and has no contraindications for treatment, and this is something you would treat in the field, if the nurse escort says no to your med administration - Whats next? For example, chest pain transfer for possible STEMI, sending facility gave 160 mg ASA and stated patient has had their full dose of ASA so they cant get any from EMS, and the sending doctor does not want patient having treatment from EMS.

Please see the Medical Directive Policy on the SWORBHP website (here). Sections 7. And 8. detail the role of Medical Directives for inter-facility transport:

7. During inter-facility transport involving a patient under the care of a regulated health professional escort, the Paramedic shall follow the current Basic Life Support Patient Care Standard, and upon request, assist with patient care only to the level in which the Paramedic is authorized.

8. During inter-facility transport involving a patient without a regulated health professional escort, paramedics may utilize the ALS PCS medical directives for unpredictable/unexpected or sudden changes in patient condition.

In the situation you describe, the sending facilitys medical doctor has taken on responsibility of care. They have the ability to provide care in a manner different from the Medical Directives.

The Medical Directives were derived to provide Evidence Based care prior to medical assessment and treatment. After medical assessment a new manner of treatment may be decided upon by the sending physician. This new treatment plan should be followed unless, as in 7. and 8. above, an unpredictable/unexpected or sudden change in patient condition occurs. If you are with an escort, you shall follow the current BLS and upon request, assist with patient care to the level in which you are authorized. If you are without an escort and an unpredictable/unexpected or sudden change in patient condition occurs, you may utilize the ALS-PCS.

Miscellaneous,Policy/Procedures

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