Question: To what extent am I allowed to take orders from a physician who is riding out with me? Are there any set guidelines to direct us and the physicians in this aspect? A recent resident riding with me said they had no issue with providing the order if it seemed reasonable. Narcan administration was used as an example as something that seemed reasonable. However the resident felt (and I agreed) something like a TOR order warranted a call to a BHP. Discussion of this subject would be appreciated.
Great question! Please take a moment and review the policy relating to physician ride outs as posted on our website here: www.lhsc.on.ca/About_Us/Base_Hospital_Program/OpsLogistics/PhysicianResidentEMSRideoutFinal2011.pdf
A rideout is primarily observational. BHP/EM Residents should not provide direct patient care except under exceptional circumstances. Any direct patient care provided by a BHP/EM Resident must be documented on the ACR. Not all physicians on ride-outs have completed the necessary requirements to provide medical delegation. During a call, only a BHP or EM Resident that has completed their Base Hospital rotation may delegate to a paramedic according to the scope of practice of that paramedic. Alternatively, they may request that the paramedic patch to the Base Hospital according to usual procedure.
Bottom line: To avoid confusion and for the sake of consistency it may be best for paramedic crews to follow standard procedure and establish a BHP patch when indicated rather than relying upon the rideout physician for medical direction.