paramedic inter facility transfer training section 1 pift overview
TRANSCRIPT
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Paramedic Inter Facility Paramedic Inter Facility Transfer Transfer TrainingTraining
Section 1 PIFT OverviewSection 1 PIFT Overview
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PParamedicaramedic
IInternter
FFacilityacility
TTransferransfer
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Interfacility Transfer
–Interfacility transfer means the transfer of a patient from one health care facility (hospital, rehab, nursing home, etc.) to another.
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Interfacility Transfer
–Interfacility transfers are done every day within the normal scope of practice as defined by Maine EMS rules
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Interfacility Transfer
–Examples:• EMT-B transfers a patient with a
saline lock
• EMT-P transfers a patient on a Fentanyl drip
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Interfacility Transfer
If the normal scope of practice is not exceeded, then no further
assistance or special circumstance is needed
As long as the patient is otherwise stable
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Interfacility Transfer
–Occasionally, the needs of the patient exceed the capabilities and scope of practice of the EMS provider
- Examples:
• A stable patient on an Amiodarone drip• A 26 week pregnant female in active
labor
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Interfacility Transfer
Under normal circumstances these patients would require
hospital staff to accompany the crew in transport
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Interfacility Transfer
The RN would be part of the team, but hold ultimate responsibility for
administering and monitoring the “non-EMS” medications, devices and
treatments.
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PIFT Program
• Developed in 1990’s to address concerns of hospitals
• Hospitals concerned with having to send staff on inter facility transfers
• They believed stable patients who had medications running that were outside the normal standard of care could be transported by paramedics alone
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PIFT Program
• MDPB determined that there are many situations where properly trained paramedics can safely transport patients who are receiving medications that are outside the identified paramedic standard of care.
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PIFT Training
• Expanded the paramedic standard of care in the interfacility setting only.
• Allowed paramedics in specific circumstances to control and administer a new list of medications and monitor and troubleshoot a variety of patient care devices.
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PIFT Training
• The trouble is the list kept expanding…
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PIFT Training
• In 2006 the MDPB updated the program to make it more universal.– Medication classifications instead of a list
• The sticking point has always been patient stability.
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Current PIFT Parameters
• Paramedics who have completed the inter facility transport program may (in a PIFT Setting):– Transport medications established by the
normal standard of care– And transport the following additional
classifications of medications:
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PIFT Medication Classifications1. Anticoagulants
2. Anticonvulsants
3. Antidiabetics
4. Antidysrhythmics
5. Antihypertensives (including ACE inhibitors, Calcium Channel Blockers, Diuretics, Alpha Blockers and Beta Blockers)
6. Anti-Infectives
7. Antipsychotics
8. Cardiac Glycosides
9. Corticosteroids
10. Drotrecogin
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PIFT Medication Classifications
• Gastrointestinal Agents (including H2 Blockers, PPI’s, anti-emetics, and Somatostatin or its analogues)
• IV Fluids, Electrolytes (including Dextran, Albumin, and Hetastarch)
• Narcotics (including all routes except epidural)• Over-the-Counter (OTC) medications• Parenteral Nutrition and Vitamins• Platelet Aggregation Inhibitors (including IIb/IIIa
Inhibitors)• Respiratory Medications (Beta Agonists, Anticholinergics,
Mucolytics and Steroids)• Sedatives (Benzodiazepines, Barbiturates)• Vasoactive Agents (Antihypertensives,
Pressors/sympathomimetics)
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PIFT Medication Classifications
o Paramedics may actually be administering some of these medications as required by the patient condition and allowed by physician order and training. o Paramedics may transport patients with central lines as long as the medications running are contained on this list.
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The MDPB defined very specific limitations for PIFT
transfers
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PIFT LimitationsPIFT Limitations
• PIFT Transfers are limited to PIFT trained paramedics– In order to be eligible to
participate in a PIFT transfer, the provider must be a paramedic who has attended a new, updated PIFT training.
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PIFT LimitationsPIFT Limitations
• Expanded protocols are limited to the “interfacility transfer setting”– Interfacility transfer setting means the transfer
of a patient from one health care facility (hospital) to another.
– PIFT trained paramedics are not allowed to use expanded protocols in any setting other than a PIFT transfer.
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PIFT LimitationsPIFT Limitations
• Services must also be permitted through MEMS as a “PIFT Service”
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Stability
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Stability
• To be eligible for a PIFT transfer, a patient must be “stable.”
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Stability
• “A patient is considered “stable” when there is no foreseeable likelihood of material deterioration in the condition of the patient as a result of or during the transport.”
Maine EMS Medical Directions and Practice Board 2006
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Stability
Assessment of stability will require:• Hemodynamic and neurologic signs
which have demonstrated no deterioration from the acute presentation of the patient, or are within acceptable limits of variation on existing therapy and….
Maine EMS Medical Directions and Practice Board 2006
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Stability
…may be reasonably predicted to remain so during the transport without the need for further adjustments to such therapy…
Maine EMS Medical Directions and Practice Board 2006
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Stability
The pathophysiology of the patient’s acute condition is known to favorably respond to the therapeutic interventions which have been undertaken at the sending hospital
Maine EMS Medical Directions and Practice Board 2006
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Stability
• Patient reports and detailed physician orders are critical components of a stability decision
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Stability
• The PIFT paramedic must have:– A detailed understanding of the patient
history as it relates to this current treatment plan
– Additional relevant patient history – Physician instructions for managing patient
change during transport.
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The final decision on whether the patient can be transported
under the PIFT program will be made
by the transporting paramedic
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There are many inter facility
transfers that will not be eligible for
PIFT and therefore must utilize hospital
staff
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Non-PIFT Situations
• Patients who are not stable according to the definition listed previously.
• Patients who are on medications or equipment that is not included in the PIFT program.
• Situations where the paramedic is not comfortable transporting without additional hospital personnel
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Bottom Line
A safe and effective inter facility transport requires the use of adequately trained personnel
utilizing appropriate equipment for the management of the
patient
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PIFT Transfers
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Pre-Trip Check
• Prior to picking up the patient the transferring paramedic receives a report:
– Patient conditions– Medications running– Required equipment
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Pre-Trip Check
Paramedic conducts a pre-trip inventory
Appropriate equipment
Gas levels Resources
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Pre-Trip Check
• Paramedic reviews operation of any required equipment to ensure proper familiarity with operation.
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Pre-Trip Check
• Paramedic reviews unfamiliar medications
– Mechanism of action– Indications– Contraindications– Precautions– Side Effects/Untoward
effects– Potential complications
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Patient Deterioration
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Patient Deterioration
• Patient must be regularly re-assessed in order to identify changes in patient condition as soon as possible.
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Patient Deterioration
• Paramedics must be acutely aware of specific physician orders and the medications that are being administered
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Patient Deterioration
• What are the orders?
• What medications need to be given to prevent deterioration?
• Are there medications to be given in the event of deterioration?
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Patient Deterioration
• If changes in the patient are dramatic, the paramedic should attempt to contact medical control
– 1st choice = Sending physician/facility
– 2nd choice = Receiving physician/facility
– 3rd choice = Diversion/3rd party physician
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Patient Deterioration
• In extreme circumstances, the paramedic may consider discontinuing the medication and utilize existing MEMS protocols to manage the patient.
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Patient Deterioration
• The transporting crew should also consider diverting to the closest hospital with an emergency department for assistance.
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Report to Receiving Facility
• The Paramedic is a key part of the patient care team and must take responsibility for continuing the communication link that passes critical patient information between caregivers.
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Report to Receiving Facility
• Information that should be passed along to the receiving facility include:
– History received from the sending facility– Assessment findings during transport– Patient general condition– Treatments administered and/or altered
during transport– Patient response to treatments or changes.
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Summary
• PIFT enables paramedics to broaden their scope of practice during interfacilty transfers
• Not all interfacility transfers will qualify for PIFT• PIFT has rigid parameters including a stability
assessment• Appropriate transport decisions must be made• Good judgment is an ongoing requirement