Note: For purposes of this protocol, “interfacility transfer” refers to transfers FROM Joplin facilities to other tertiary care hospitals outside of the immediate southwest Missouri area. ALL advanced medical & trauma patients are to be attended by a paramedic.
Follow General Medical Protocol.
All patients being transported should have cardiac monitoring.
Any patient who is intubated and, on a ventilator, should have a respiratory therapist accompanying them.
Crew should receive report from transferring nurse to include reasons for transfer, stability of patient, pertinent medical history, and anticipated complications.
a. ALL medications (including drips) are to be verified with the transferring nurse. This includes rate of administration & any indications for adjusting the dosage or discontinuing medication during transport.
b. If the patient has a “Do Not Resuscitate” order, this should be clearly documented.
c. Office & pager numbers for transferring physician should be obtained before departure.
Monitor & document patients’ vital signs & cardiac rhythm every 30 minutes – 1 hour (or more frequently as condition dictates).
Unless contraindicated, pain may be treated with FENTANYL 50 - 100 mcg IV every hour as needed.
a. Indications for withholding or discontinuing fentanyl
i. BP < 100 systolic
ii. RR < 10
iii. Decreased mental status
Unless contraindicated, nausea/vomiting may be treated with ODANSETRAN (Zofran) 4 – 8 mg IV every 4 hours.
If excessive anxiety, agitation, or delirium is present which is compromising their safety AND is not responsive to verbal de-escalation techniques (“talking them down”), patient may receive KETAMINE 0.5 – 1 mg/kg IV every hour as needed during transport. Always assess for oxygenation problems or hypoglycemia prior to use of ketamine administration.
For any other complaints, follow the appropriate EMS protocol.
In case of emergency, you should attempt to make contact with the transferring physician. If unsuccessful, you may contact ED on-line Medical Control of transferring hospital for consultation/orders.
Special circumstances
a. Trauma
i. Assess vital signs frequently while enroute.
ii. Get report regarding all known and suspected injuries.
iii. Transporting TO Joplin from outlying hospital
Patient should be transported with cervical collar in place.
It is highly recommended that patient be transported on a long spine board UNLESS patient is fully awake, not intoxicated AND has no back pain.
IV fluids should be set at rate dictated by transferring physician.
Pain medication as per protocol
b. Blood (and blood products)
i. Assess and record vital signs, including temperature, prior to transport.
ii. Reassess patient frequently during transport.
iii. Document the unit blood bank number of all units sent with patient.
iv. Instruct the patient to report the onset of any unusual symptoms that might indicate a transfusion reaction:
Chills, restlessness, headache, dizziness, nausea, anxiety, new back pain, chest pain, or dyspnea
v. Watch for signs of a transfusion reaction:
Fever, facial flushing, bradycardia, distended neck veins, cyanosis, tachycardia, rash, sweating, or hypotension
vi. If a transfusion reaction is suspected:
Discontinue the transfusion, save the remaining blood, bag, and tubing
Maintain IV with NS
Notify the transferring physician
Draw blood samples (if tubes available) from a site other than transfusion site
Treat complaints via EMS protocols
c. Heparin
i. Confirm drip rate with transferring physician/nurse.
ii. If patient develops unexplained neurologic symptoms, such as headache, numbness, seizure, etc., discontinue drip and contact on-line Medical Control.
d. Nitroglycerin
i. Confirm drip rate with transferring physician/nurse
ii. If systolic BP drops below 90, stop the drip and give patient a fluid bolus of NS 250 mL.
e. Ventilator patients
i. Patients on a ventilator should ALWAYS have a respiratory therapist (RT) on board.
ii. Ventilator settings are to be documented on the transfer orders.
iii. Any patient on a ventilator who also has continuous IV sedation medication infusing (i.e. propofol) will require the presence of an RN during the transport. If this is not possible, the transferring hospital will be asked to convert patient to both a midazolam (VERSED) and fentanyl drip for sedation.
12. Other medications being administered via IV continuous drip AND not requiring active titration that are acceptable to be monitored by EMT-P includes:
a. Antibiotics
b. Anticonvulsants
c. Antihypertensive agents
d. Insulin
e. Gastrointestinal agents
f. Magnesium
g. Parenteral nutrition
h. Vasopressors
13. An EMT-P should not transport any patient with a drug that he/she is not comfortable with. In this case, EITHER contact the supervisor OR request that an RN accompany on the transfer.