Question: I am a PCP-IV medic who recently transferred a patient between facilities - from county hospital to trauma centre. On arrival I was told by the attending physician that the patient was to be spinal immobilized as a precaution as instructed by the trauma centre. The physician also informed me that the trauma centre requested that the patient receive 1000ml NaCl prior to arrival at the LTC. I inquired about the patient's vitals and assessed the patient as normotensive with no indications of poor perfusion. I told the physician that my protocols did not permit me to fluid bolus the patient with up to 1000ml enroute unless the patient was hypotensive and remained hypotensive. Moreover the sending facility was not sending an escort on this long CODE 4 STAT transfer. I called my Duty Manager for advice and was told to abide by my directives and follow the BLS standard for IV monitoring - 200ml/hr max pending patient presentation enroute. This is the direction I proceeded with. My question is - was I correct in my course of action and was it advisable to press the physician for an escort based on the requirements of the LTC?
Excellent question. You were correct. You can only function to the limit of your scope of practice.
In terms of the patient stability and the role of including a possible medical escort, this is a real issue that you must communicate with the sending physician. You should explain your concerns regarding the patient condition; explain the limits of your scope of practice and your ability to intervene if the patient were to deteriorate.
Ultimately, the sending physician is responsible for the welfare of the patient on transport and the role of appropriate medical escorts. However, when situations have arisen in the past, crucial conversations as to the various escorts that may be available to assist you (RT, RN, MD, Ornge) have led to enhanced patient safety on transport. Your supervisor and or the Base Hospital Physician may also be a useful resource if you are confronted with a transport where you feel the patient may benefit from an enhanced scope of practice. The Base Hospital will stand behind you in addressing safety concerns you may have when asked to transfer an unstable patient you feel requires additional medical escorts.