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Inter-facility Transfers - Patient under our care or care of sending physician?

Question#: 516


Hello I have a question regarding inter-facility transfers. In the case of a transfer, is the patient under our care or is this patient under the care of the sending physicien?

The reason I ask is in regards to our medication protocols. Can we start a symptom relief protocol (ex: gravol for nausea/vomiting) during transport for this patient or must we patch for BHP approval? Would asking the sending physicien before departure for their approval of gravol be sufficient if it is indeed considered their patient?

If I was transferring a patient with mild chest pain that has received morphine before their departure, could I continue morphine administration during transport if the patient suddenly has severe pain or would a patch be required in this case?

Thank you for your time.


Hello Kevin,

Great question, we apologize for the delay responding to your submission.

Providers have a duty of care for each patient they see. In an interfacility transfer, there is a pendulum of responsibility with the providers involved in the patient's care. The sending facility, receiving facility, and out-of-hospital medical oversight physicians all have accountabilities to the patient, they all share the duty of care in addition to your immediate duty of care as the patient's medical provider during transport.

Paramedics licensed under the RPPEO have the ability to treat patients who fall within their scope of practice and medical directives. If a patient under your care experiences a medical emergency, or medical issue that is treatable within the scope of your practice you have the ability to follow the medical directives during interfacility transfers.  

The most collaborative approach when caring for an interfacility transfer patient is to understand their reason for transport, their underlying medical condition being treated, and their current care plan. Understanding their current care plan can help you make decisions on route, and talk about patient management with the sending facility. Engaging the sending facility in a transfer of care conversation helps mitigate potential adverse events, or patient safety issues during transport. 

We also encourage all paramedics to consult a BHP at any time if you are unsure or have questions about the patient's condition. A consult with a BHP can extend orders, provide advice or guidance on patient management, and help identify risks in the patient's journey.

If you have further questions we would be happy to discuss in more detail.




23 February 2022



Please reference the MOST RECENT ALS PCS for updates and changes to these directives.