PCP or ACP - For a CTAS 1 patient who is in the back of ambulance?
Question# 579
Hello,
In regards to a PCP and ACP working together. If we have a return CTAS 1 patient what is the direction we are being given as to who is in the back. If the PCP is comfortable being in the back and the care the patient is receiving is something within the PCP scope could they be in the back? The way I see it is that if we are both comfortable with the PCP being in the back and something goes south the initial care is going to be no different between PCP and ACP. A, B, C, reassessment and vitals and by that time the ACP partner has pulled over and is in the back and likely still doing PCP skills until ACP care can be initiated.
Or lets say something like narcotics administration. As a PCP I can manage and treat an overdose. But suddenly when I have an ACP I am incapable of doing it? As a PCP I can do an inter facility transfer where the patient has been given narcotics but I am unable to be in the back when my ACP partner has? Any clarification would be appreciated :)
Answer:
For context, about 10 years ago, the RPPEO did hold a policy with black and white direction regarding when an ACP should remain with the patient enroute to definitive care. Over the last few years, with paramedic, service and Medical Directors’ consultation, this approach has been archived in favour of an emphasis on open crew communication and sound clinical judgement.
The 2016 CME cycle addressed these changes, primarily surrounding examples, and highlighted the ALS PCS Responsibility of Care. These discussions underscored variables such as transport time, presenting complaint(s), potential for ongoing treatment and paramedic comfort level. Incorporating these aspects and maintaining open dialogue both prior to and during transit plays a considerable role in patient safety. If you choose to transfer care to your PCP partner, this may be documented as a TOC in the procedures section.
Generally speaking, it is encouraged that the ACP remain in the back for CTAS 1 patients due to the higher possibility of rapid deterioration. Although it is possible to pull over and switch positions, this may be unsafe (depending on roadway conditions etc.) and ultimately delay transport to definitive care. In addition, it may be in the best interest of the patient to maintain care in cases of STEMI, for example, when individuals have significant potential for sudden arrhythmias/arrest.
The bottom line is that we trust you and your partner will discuss the clinical risks of the patient and the patient management strategy on a case by case basis regarding what level of care during transport is best for each individual.