I have had a few calls to nursing homes where the patients IV fell out and the patient is being sent to the hospital for an IV restart. If the patient does not have any complaints otherwise, would an IV certified crew be able to start the IV and patch to not have the patient transported? If so, would this be documented as a refusal? I have always transported these patients but it would be helpful to know if there are other options to avoid an unnecessary trip to the hospital. Thank you!
When it comes to IV initiation in the 9-1-1 system, there are risks with completing this procedure and then leaving the patient at home. Why is the IV in place: Has the condition worsened? Who is going to follow up with the patient and monitor the IV site and infusion? Furthermore, the Intravenous and Fluid Medical Directive was not developed for the purposes of treat and release, but rather for medical treatment (or potential need for medical treatment) for 9-1-1 patients that require emergent care. The safest thing to do in these scenarios when a 9-1-1 call is initiated for an IV start is to transport the patient to hospital.
The 9-1-1 system is designed so that when a patient calls they are conveyed to hospital unless they have capacity to refuse transport. The Ministry is now working on new Patient Care Models whereby not all patients that call 9-1-1 are transported to hospital and as such models of treat and release, treat and refer, or treat and transport to alternate destinations, are being developed, piloted and reviewed. Of note, the Ministry is working with the Ontario Base Hospital Group and reviewing patient populations as part of the Phase 2 roll out of alternate Patient Care Models within the 9-1-1 system. This may be one patient population that the Ministry is interested in studying for these Patient Care Model Standards.
Unfortunately, the use of 9-1-1 paramedics to initiate IVs (ex. on behalf of home care nurses or Long Term Care facilities) may have some unintended consequences whereby resources from the 9-1-1 system are being utilized inappropriately and 9-1-1 paramedics become the traveling IV team. However, for now, SWORBHP Medical Council would not recommend the routine practice of patching to the BHP to start an IV and leave the patient behind, for the reasons stated above.
There are agreements between some services and physicians/care practitioners to provide paramedic care to patients outside of the 9-1-1 system, via Community Paramedicine. In this model, the paramedics can utilize skills as directed by a medical director separate from SWORBHP. This care team closely follows up on patients, providing ongoing care. This may be one avenue that some Services have to deal with these types of community calls that should not be within the realm of 9-1-1 care.