Base Hospital Physician (BHP) Patching​

Patching to the BHP

Patching in the Pre-Hospital Setting​

• The vast majority of physician direction to Paramedic practice comes in the form of "Offline Medical Direction" via pre-approved Medical Directives in the ALS PCS. ​
• Occasionally, Paramedics must patch for "Online Medical Direction"​
  • Functionally this provides real-time information and orders from a Base Hospital Physician​
• Patching can include requesting orders or seeking clarification on Medical Directives

Patching: An ORDER from the physician must be given​

• Paramedics may REQUEST orders from the BHP​
• HOWEVER, the BHP must GIVE an order: They explicitly tell you the order they are giving.

Patching in the Pre-Hospital Setting​

• This online medical direction can be for:​
  • Mandatory patch points built into the ALS PCS Medical Directives ​
  • Seeking clarification on applicability of Medical Directive treatment​
  • Request to provide treatment outside of the Indications/Conditions/Contraindications and Treatment tables as written into the Medical Directives​
    • Example: Requesting to give more medication doses when encountering a delay to transfer of care ​
  • Request to provide treatment with a medication that doesn't have a Medical Directive​
    • Example: Sodium Bicarbonate

What can a Patch Physician Do?​

They CAN

• Provide online (real-time) medical support in the form of physician “orders” ​
• Provide alternate or extension of dosages of medications that are within paramedic scope of practice

They CANNOT

• Direct paramedic traffic/destination​
• Direct paramedics to work outside of their scope of practice​
• Talk directly to a patient

Paramedics Can Only Follow Orders from Base Hospital Physicians

• Paramedics can ONLY follow orders from trained BHPs​
  • BHPs receive training and ongoing CME in order to provide appropriate Medical Direction​
• In the SWORBHP Region, BHPs include:​
  • A few Emergency physicians throughout the region with a special interest in prehospital care who cover the patch phone several days/nights per month​
  • The LHSC Adult Emergency Department physicians when they are contacted through the patch phone ​
• Physicians who are not BHPs cannot direct Paramedic practice​
  • They can direct care to their own staff after transfer of care from the paramedics​
  • They can direct care of a patient during transport to their own staff members ​
    • Example: An RN accompanying a patient in transport can continue a fluid bolus as directed by the sending physician. However, the sending physician cannot direct paramedics to give a fluid bolus.

No additional resources available for this #SWORBHPTip.