Effective: 10-31-24
Supersedes: 06-22-20
Purpose: To ensure that every ALS Inter-facility Transfer is completed by a properly certified, trained and equipped Advanced Life Support Unit.
Policy: Crews shall obtain a working knowledge of a patient’s status, when necessary contact medical control to obtain approval to transfer a patient, and then maintain the level of care a patient had been receiving from the sending facility to the receiving facility.
Definition(s):
ALS Inter-facility transfer refers to the transport by ambulance from one health care facility to another of a sick or injured patient who requires medical treatment and/or monitoring of an on-going medical treatment, consistent with the appropriate scope of practice.
Health Care Facility refers to any health care setting where patients will be stabilized such that an emergency ambulance response is not typically required; this will require the supervision and/or on-site presence of a physician, Advanced Practice Providers (“APP” such as Physician Assistant, Nurse Practitioner, etc.) and other individuals trained and equipped to provide such care.
Stable Patient refers to patients that must either be evaluated and determined to be stable by a physician on-site at the sending facility or deemed to be stable for ambulance transport by the attending physician or APP. A patient shall be considered stable if (1) at the time the transfer decision is made, the patient’s medical condition does not exceed the care capability of the transferring ambulance, and (2) deterioration of the patient’s medical condition to a level that exceeds the care capability in the transferring ambulance is not anticipated during the transport.
Procedure
When appropriate, medical control orders shall be obtained prior to transport. Notification to Medical control shall include a patient report, plan of treatment, and a request for any medical control options that may potentially become necessary during transport.
On rare occasions, it will be necessary to transport time-sensitive unstable patients to a facility that can provide advanced interventions. This transport shall be at the discretion of medical control. Examples of these unstable patients may include complicated birth, multi-systems trauma, and complex medical patients requiring interventions not available at the sending facility.
Medical control shall be documented on the patient care report; this shall include the physician’s name and/or number, the hospital providing control, and any orders requested and/or received.
No Ambulance Service or agent thereof shall transport a patient between healthcare facilities who are receiving medical treatment that is beyond the training and certification capabilities of the EMTs staffing the ambulance unless an additional health care professional with that capability accompanies the patient. In some cases, this role may be fulfilled by a family member (e.g. a parent managing the ventilator of their stable, chronically-ventilated child).
When a facility sends its own staff with the patient during transfer and the patient decompensates en route, the ALS provider shall notify the medical control physician for guidance and/or orders.
Thorough documentation of all assessments, treatments and changes in patient status shall be written on the electronic Patient Care Report Form.
Patient care shall be transferred to the staff of the receiving facility in compliance with Brewster and EasCare Ambulance Service.
Interstate transfers are permitted. ALS providers must obtain Medical Control through normal channels, through the affiliation agreement for medical control. Appropriate provision for re-contacting the medical control physician en route, if necessary, should be made prior to departure from the transferring facility. If a transfer originates out of state and no contact with medical control physician is possible, the transfer should be made at the BLS level only with appropriate additional personnel provided by the transferring facility.