what do ems need to use in report subjective info on interfacility patient transfer

by Dr. Orrin Baumbach PhD 4 min read

Guide For Interfacility Patient Transfer - EMS

15 hours ago  · The use of emergency medical services (EMS) inter-facility transport ensures that a patient receives the care they need in a time-efficient and safe manner. For clinicians, understanding the role EMS services play in tranpsort is essential for the proper use and referral.[2] ... Inter-hospital transfer of a patient may occur in emergent and non ... >> Go To The Portal


What is the guide for interfacility patient transfer?

Guide for Interfacility Patient Transfer Providers involved in interfacility transfer of un- stable, critically ill, or injured patients should have the ability to continuously monitor and assess the patient’s condition and to intervene appropriately At a minimum, this would require skill and knowl- edge in the areas of:

What information is required when transferring a patient to another hospital?

nThe transferring hospital must send copies of all medical records related to the emergency medical condition If the physician on call refuses or fails to assist in the patient's care, the physician's name and address must be documented on the medical records provided to the receiving facility Guide for Interfacility Patient Transfer 

What is EMS inter-facility transport?

EMS Inter-Facility Transport - StatPearls - NCBI Bookshelf Inter-facility transport is defined as the transport of patients between two healthcare facilities. The process is generally accomplished through ground transportation or air vehicles.

What are the laws for patient transfer in emergency medicine?

Emergency physicians, advance practice providers, and facility personnel should abide by applicable laws regarding patient transfer. All patients should be provided a medical screening examination (MSE) and stabilizing treatment within the capacity of the facility before transfer.

Where should critically ill children be treated?

To ensure the best possible health outcomes, critically ill and injured children should be treated at the facilities most prepared to address their needs. Often, however, children are treated at local community emergency departments where pediatric specialty services are not available – i.e. pediatric burn care.

Do hospitals have to have written arrangements for transferring pediatric patients to specialized centers?

Therefore, healthcare facilities should have available written arrangements to formalize their procedures for transferring pediatric patients to specialized centers for optimal care. Such arrangements include both interfacility transfer agreements and interfacility transfer guidelines.

Who is responsible for medical oversight of an EMS transport?

Generally, medical oversight during transport will reside with the medical director of the EMS transport agency , but this may vary depending on the jurisdiction. In some instances, the transport agency may not have a medical director and authority may come from a jurisdictional (e.g., county) EMS medical director.

What is an EMS communications plan?

Develop a communications plan that describes if and when the EMS transport agency, emergency management, law enforcement, public health, and the sending and receiving facilities will need to communicate with each other and how they will communicate (e.g., cell phones vs. radios that could be monitored by scanners).

What determines the appropriate level of PPE for each member of the transport team?

Determine the appropriate level of PPE for each member of the transport team based on patient condition and symptoms, length of transport, operating environment, provider competencies, availability of supplies, and guidelines provided by CDC and supported by the EMS agency medical director. Involve stakeholders in these discussions, including EMS, public health, and clinical care providers. The determination should also consider a worker’s ability to wear certain types of PPE (e.g., medical clearance, and fit testing).

What is EMS planning?

What this is for: Developing plans for personnel, including ground and air medical transport providers, managers of EMS agencies, EMS medical directors, local and state EMS systems, local and state health departments, healthcare facilities, and others involved in the interfacility (including intrastate or interstate), transport of persons under investigation ( PUIs) or patients with confirmed Ebola virus disease (Ebola).

When should coordination occur in public health?

Coordination among public health, healthcare, EMS, healthcare coalitions, law enforcement, and emergency management should occur during all phases of preparation and planning, and throughout the interfacility transport, as appropriate.

What are the considerations when developing plans for ambulance preparation?

Consider the following when developing plans for ambulance preparation: patient symptoms, length of time required for the patient transport, whether the driver compartment is isolated from the patient, and whether a designated transport vehicle will be used. 29,30

What should be included in a transport protocol?

Develop protocols for the management of the patient during transport. This should include any invasive procedures (e.g., suctioning , resuscitation) that should or should not be performed during transport in order to reduce the potential risk of exposure (see Section 8: Clinical Care during Transport ). Consider including a medical ethicist, infectious disease physicians with expertise in this area, and labor unions in these conversations. Determine if scope of practice of the transport providers is affected with interstate transports.

What does the examining physician do when transferring patients?

The examining physician at the transferring hospital will use his or her best judgment regarding the condition of the patient when determining the timing of transfer, mode of transportation, level of care provided during transfer, and the destination of the patient.

What is the mode of transportation for a patient transfer?

The mode of transportation used for transfers should be at the discretion of the treating provider and based on the individual clinical situation, available options, needed equipment and patient preference. Options for transport include but are not limited to ambulance, air-transport and private vehicle. Regardless of the method of transfer, intravenous access may remain in place if deemed appropriate by the referring provider.

What is the transferring facility?

The transferring facility is responsible for informing the patient or responsible party of the risks and the benefits of transfer and document these. Before transfer, patient consent should be obtained and documented whenever possible.

What is MSE in medical?

All patients should be provided a medical screening examination (MSE) and stabilizing treatment within the capacity of the facility before transfer. If a competent patient requests transfer before the completion of the MSE and stabilizing treatment, these services should be offered to the patient and informed refusal documented.

What is the goal of patient transfer?

The optimal health and well-being of the patient should be the principal goal of patient transfer.

When transfer of patients is part of a regional plan to provide optimal care at a specialized medical facility, should?

When transfer of patients is part of a regional plan to provide optimal care at a specialized medical facility, written transfer protocols and interfacility agreements should be in place. To ensure optimal patient care, non-hospital medical facilities should abide by transfer standards much the same as those outlined above.

How to accept a patient in transfer?

Agreement to accept the patient in transfer should be obtained from a physician or responsible individual at the receiving hospital in advance of transfer. When a patient requires a higher level of care other than that provided or available at the transferring facility, a receiving facility with the capability and capacity to provide a higher level of care may not refuse any request for transfer.

What is the purpose of interfacility patient transfers?

Patient transfers are a physician to physician referral. It is the responsibility of the transferring facility to perform a screening examination, determine if transfer to another facility is in the patient’s best interest and initiate appropriate stabilization measures prior to transfer.

What is the responsibility of a transferring physician?

It is the transferring physician’s responsibility to know and understand the training and capabilities of the transporting EMS personnel. During transport, the transferring physician is responsible for patient care until arrival of the patient at the receiving facility.

Background

Standard Operating Procedures

  • Content of SOPs
    1. Issues to be addressed in the SOPs for an EMS transport agency likely to conduct interfacility transport may include the following: 1.1. Education, training, exercises, and refresher training 1.2. Notification, decision-making, logistical support, and communication12,13,14,15 1.2.1. Mission …
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Patient Preparation

  • Considerations
    1. Include plans for patients with functional or access needs (e.g., hearing, vision, limited mobility), device dependence, and limited English proficiency, and for pediatric or elderly patients. Consider the developmental stage of the patient, especially with pediatric patients, when addres…
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Additional Considerations During Transport

  • Route
    1. Discuss the planned transport route with state/local law enforcement and emergency management, and determine how to secure the route. Determine whether a security escort will be needed during the transport and, if so, who will provide the escort (e.g., local, state, tribal, federa…
  • Other
    1. Determine if there will be a vehicle following the ambulance and who will staff that vehicle (e.g., additional EMS staff, medical director, physician, law enforcement). 2. Consult current infection control guidance25and establish a plan to manage provider exposure (e.g., fluid exposure, needl…
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Waste

  • Considerations
    1. Establish plans/protocols for handling waste that are consistent with the state plan, including how medical waste will be packaged at the receiving facility, how long waste will be held at the facility, who will transport the waste to the medical waste disposal facility, which medical dispos…
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Patient Death During Transport

  • Considerations
    1. Coordinate with the regional ETC to determine if they will accept the body of a patient who dies in the ambulance during transport. 2. Ensure that agreements are in place with mortuary facilities. 3. Collaborate with healthcare and public health officials to determine who will perform postmor…
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Pediatric Considerations

  • Considerations
    1. Determine appropriateness of parental/guardian presence for children. 2. Ensure that capabilities and protocols exist for transporting pediatric patients, with details for how to handle those with special healthcare needs, those who are device dependent, or those with access and …
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