Question: As a PCP, can you do an inter-facility transfer with a patient with IV running lactated ringers without an escort?

 Great question. You have identified one of the missing links in the BLS Patient Care Standards (BLS-PCS). Given the IV certification of many PCP, the Intravenous Line Maintenance Standard for PCP requires updating.

The current version can be found in Section 1 page 41 here: www.health.gov.on.ca/english/public/program/ehs/edu/pdf/bls_patient.pdf

You will note that the type of fluid is not specified (although saline, heparin locks, thiamine and potassium chloride are all mentioned as acceptable). Ringer's lactate is not mentioned by name.

Out of a similar question from a PCP student over a year ago, multiple updates to the BLS Intravenous Line Maintenance Standard were brought to the Ministry of Health Emergency Health Services Branch (MOH-EHS) by the Southwest Base Hospital including the need to specify types of fluids that are acceptable. These edits (like many others to the BLS-PCS) are awaiting release in a new BLS manual expected in the coming year.

Bottom line to answer your question, isotonic crystalloid infusions such as normal saline and Ringers Lactate are acceptable for a PCP to maintain at a TKVO rate as per the current BLS Standard up to a maximum infusion rate of 200ml/h in an adult patient.

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