ALS vs BLS Medic - Narcotic Administration
I've been approached by ALS medics with regards to narcotic administration and letting their BLS partner take over attending for transport. What is the Policy on this decision. I have some ALS who have done this and have not been given any feed back if this was the wrong decision. So...it appears that there are two different approaches in this matter as per the ALS medics, attend or not.
Great question, there is no clear definition for when an ACP or PCP should attend to a patient. We rely on clinical judgment to determine the most appropriate level to provide care to our patients.
The Responsibility of Care standard empowers the highest level of care (typically an ACP on scene) to make a clinical judgment as to the level of care reasonably foreseeable during transport. The standard outlines the highest level of care (ACP) will remain responsible and accountable for the patient, in addition to the the PCP up to their scope of practice. The RPPEO supports and endorses paramedic judgment to determine who should attend to the patient while on route. The decision should consider the patient's condition, the reasonably foreseeable risks of the patient's status changing on route, and the crew should discuss those risks prior to determining the most appropriate level of care for the patient.
There is no contradiction in the ALS PCS for the ACP to give a patient opioid analgesia and the PCP to attend during transport.
The patient risk assessment should consider the patient's condition, reasonably foreseeable treatment on route, and possible interventions required if the patient deteriorates. For example, if the patient is experiencing severe pain, the provider best suited to manage the patient's severe pain should attend. If the patient could become severely hypotensive, or have a sudden arrhythmia based on their presentation and past medical history, the provider best suited to manage the patient's hemodynamic stability or cardiac rhythm should attend to the patient.
The best practice, supported by the ALS PCS, suggests that the highest level of care is ultimately responsible for the patient, and the reasonably foreseeable risks should be discussed with the partner prior to transport to ensure the most appropriate level of care manages the patient's medical needs.
When looking at patient care reports, RPPEO assesses patient care and ensures it aligns with best care possible and fewer risks.
ALS PCS, Responsibility of Care:
While on scene, the highest level paramedic shall assess the patient and make a decision on the level of care required, and on the level of paramedic required for the care of the patient.
In all patient care, the highest level of paramedic is responsible for the care of the patient, including decisions on the level of care required during transport.
A paramedic may choose to assign aspects of care and procedures to an alternate level paramedic, as long as the care and procedures are within that paramedic’s scope of practice.
Paramedics must alert the highest level paramedic of any change of patient status.
We are happy to discuss further. This is a complex decision made as a team.
Please reference the MOST RECENT ALS PCS for updates and changes to these directives.