Date Published

December 3, 2014

Updated For

ALS PCS Version ALS PCS Version 5.2


Question: There was a question posted on Sep 23, 2014 in regards to a fluid bolus on a transfer between facilities. As I agree that there should have been an RN escort for this patient, the paramedic was certified in IV fluid therapy including boluses. Your answer has me perplexed however. If a physician gave the paramedic a fluid bolus order how would that differ from getting a similar order from a BHP through phone patch. It is in the scope of practice for the paramedic to administer NaCl 0.9% as a bolus, the volume was prescribed by the physician(s) in charge of this patient's care. Would any paramedic be wrong in following the order given by the physician?


_x000D_ _x000D_  Great question. Sorry that our answer was confusing. Paramedics follow medical directives that are created by medical directors from the Ontario Base Hospital Group. Controlled acts such as intravenous and fluid therapy which are listed in the Advanced Life Support Patient Care Standards (your medical directives) can be delivered by paramedics through a delegating relationship with Base Hospital Physicians (BHP)._x000D_ _x000D_ In other words, paramedics receive their protocols and their orders from BHP and that is why a patch would have been required unless the medical directive did not require BHP contact._x000D_ _x000D_ That being said, in the case you describe, it is an inter-facility transport with an RN escort. This is different than the situation when you as a paramedic are transporting someone from the community to the hospital under the delegation model described above. You are now transporting a patient from a health care facility who is under the care of a physician. Therefore the responsibility of the care of that patient truly rests with the sending physician and that is why sending an RN with orders to provide care and interventions such as fluid boluses (or blood or other medications) is the most appropriate course of action._x000D_ _x000D_ We know however that not always is an RN sent in these inter-facility transports. Therefore, if orders are required for ongoing care of the patient while on transport under paramedic only care, the default remains that paramedics must follow their medical directives and establish BHP contact since this is the delegation model for the delivery of controlled acts._x000D_ _x000D_



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