Alabama Administrative Code › Title 420 - ALABAMA STATE BOARD OF HEALTH › Chapter 420-2-1 - EMERGENCY MEDICAL SERVICES › Section 420-2-1-.24 - Patient Transfers

Current through Register Vol. 42, No. 9, June 28, 2024
(1) No
			 person or facility of any type shall order, arrange, or conduct a transfer of a
			 patient in a recumbent position by ground or air ambulance unless transport of
			 the patient is done by an emergency medical provider service licensed by the
			 Board in an ambulance permitted in accordance with the level of care (ALS or
			 BLS) the patient needs, or is likely to need, during transport. Each ambulance
			 transporting patients between facilities shall have, in addition to a driver or
			 pilot, at least one EMSP licensed at a level which will allow the EMSP to
			 provide the care the patient needs or is likely to need. The provider service
			 medical director is responsible for assuring, in advance, that the ambulance
			 and EMSP have the capability to meet the patient's expected needs. The
			 transferring physician will ensure that the level of patient care, staffing,
			 and equipment during transport is appropriate to meet the current and
			 anticipated needs of the patient.
(2) The transferring hospital should provide
			 a complete medical record or patient chart to the receiving hospital. The
			 emergency medical provider service operator shall ensure that a complete and
			 accurate patient care report, as prescribed by the Board, is submitted for each
			 transfer.
(3) In addition to the
			 fluids and medications which a paramedic may administer to an emergency
			 patient, they may administer, perform, and maintain other types of I.V. fluids
			 and medications during the transfer of a stabilized patient on the signed,
			 written order of the transferring physician given to a paramedic in advance.
			 The following conditions apply:
(a) The
			 patient shall be deemed by the transferring physician to be appropriately
			 stabilized to permit transport to another healthcare facility by the mode of
			 transport selected.
(b) The
			 transferring physician shall have communicated to a paramedic all necessary
			 aspects of patient management and the administration or maintenance of
			 specified fluids, medications, equipment, and procedures that would be
			 administered or maintained during transport.
(c) During transfers, a paramedic may be
			 authorized to administer or maintain infusion of the classification of fluids
			 and medications, perform procedures, or maintain equipment identified herein
			 only after successful completion of the continuing education course of
			 instruction approved by the State Board of Health entitled, "Administration and
			 Maintenance of Fluids, Medications, Procedures, and Equipment during
			 Inter-hospital Transfer of the Stabilized Patient," and have in his or her
			 possession documented evidence issued by the OEMS attesting to the completion
			 of such training. In addition, the service medical director, regional medical
			 director, and SEMCC shall approve, in writing, specific medications under each
			 general classification. This written approval shall be on file with the
			 transferring institution and the OEMS, and shall be renewed annually.
(d) The specific classifications of I.V.
			 fluids and medications which a paramedic is authorized to administer or
			 maintain are strictly limited to the following, or their generic equivalents,
			 for administration or maintenance only in the dosages, forms, frequency, and
			 amounts as ordered in writing, in advance, by the transferring physician:
1. Vitamin, mineral, and electrolyte
			 infusions.
2. Central nervous
			 system and neuromuscular agents.
3.
			 Anticonvulsants.
4. Antipsychotics,
			 anxiolytics, antidepressants.
5.
			 Anti-infective agents.
6.
			 Antineoplastic agents.
7.
			 Respiratory agents.
8.
			 Cardiovascular agents.
9.
			 Gastrointestinal agents.
10.
			 Endocrine and ophthalmic agents.
11. Reproductive agents.
12. Circulatory support
			 agents.
(e)
			 Administration of thrombolytics by paramedics will be administered by
			 established Alabama EMS Patient Care Protocols.
(f) The specific invasive procedures and
			 equipment which a paramedic is authorized to administer or maintain during
			 transfers are strictly limited to the following as ordered in writing, in
			 advance, by the transferring physician:
1.
			 Portable Ventilators.
2. Chest
			 Tubes.
(g) A written
			 order, signed by the transferring physician containing the following elements
			 of information, shall be completed and delivered to the receiving hospital with
			 the patient:
1. The patient's name and
			 diagnosis.
2. The name and
			 signature of the transferring physician.
3. The name of the transferring
			 hospital.
4. The name of the
			 paramedic accepting the patient for transport.
5. The name of the receiving
			 physician.
6. The name of the
			 receiving hospital.
7. The date and
			 time the patient was released by the transferring physician.
8. The date and time the patient was accepted
			 by the receiving physician.
9. All
			 fluids and medications administered or maintained or both.
10. Specific medical orders and detailed
			 prescriptions clearly specifying dosages and frequency.
11. All required life support equipment the
			 patient needs or is likely to need.
12. Other remarks as appropriate related to
			 patient management.
13. Patient's
			 personal belongings should be signed off for by the patient's family when given
			 details of the patient to the receiving hospital. If no family is available,
			 they should be signed off for by the staff at the receiving hospital.
(h) All medications required by
			 the transferring physician to accompany the patient or medications which are
			 already infusing should be supplied by the transferring hospital. All
			 medications provided for use during the transfer together with all unused
			 medications, syringes, vials, or empty containers shall be accounted for by the
			 paramedic in the same manner in which the transferring hospital would normally
			 do so or require.
(i) Documentation
			 shall account fully for all medications administered or maintained during
			 transfer.
(j) All medications
			 authorized to be administered or maintained during inter-hospital transfers
			 shall be stored, managed, and accounted for separately from those in the normal
			 paramedic's medication container for pre-hospital emergency care.