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Patch Failures
Question# 985
There has been conflicting information with the ACP teachers at the college in terms of what an ACP is allowed to do if a patch fails after reasonable attempts to contact the BHP were made. The understanding is that for mandatory patch points, the paramedic may still go ahead with the treatment protocol as per standard other than for TOR situations. Unfortunately, it's not as clear for orders that fall outside established protocols.
Would it be possible to clarify the highlighted quote in the ALS PCS as it is very vague and open to interpretation. There is also no mention of scope of practice for this portion and therefore does this mean any potential critical interventions or what falls in the paramedic scope of practice. If it is considering the paramedic scope of practice, does it refer to the Paramedic National Competency Profile or the local Paramedic Scope of Practice allowed by its local BHP.
Finally, Would it be possible to provide a few examples of situations and what the ACP is expected to do. (Ex. Patch failure for; Sodium Bicarb for TCA overdose, Needle Cric without access to the protocol locally for airway obstruction, ACLS treatment for pediatrics falling outside the protocol, usage of Atropine for Organophosphate poisoning when this protocol is not available locally (same thing for Hydrofluoric Acid), and any other situation you would see the benefit in clarifying.
Would it be possible to clarify the highlighted quote in the ALS PCS as it is very vague and open to interpretation. There is also no mention of scope of practice for this portion and therefore does this mean any potential critical interventions or what falls in the paramedic scope of practice. If it is considering the paramedic scope of practice, does it refer to the Paramedic National Competency Profile or the local Paramedic Scope of Practice allowed by its local BHP.
Finally, Would it be possible to provide a few examples of situations and what the ACP is expected to do. (Ex. Patch failure for; Sodium Bicarb for TCA overdose, Needle Cric without access to the protocol locally for airway obstruction, ACLS treatment for pediatrics falling outside the protocol, usage of Atropine for Organophosphate poisoning when this protocol is not available locally (same thing for Hydrofluoric Acid), and any other situation you would see the benefit in clarifying.
Answer:
Patch failures are exceedingly rare in the current system, as most connection issues are resolved with repeat attempts and paramedics are typically able to establish contact with a Base Hospital Physician (BHP). In addition, it is important to remember that when there are ongoing cell phone or communication difficulties, CACC can often assist in troubleshooting or re-establishing communication pathways. We have had a number of patch difficulties resolved quickly once CACC became aware of the issue.
For the purposes of clinical decision-making, a patch failure can be understood as an inability to establish contact despite reasonable and repeated attempts in a situation where patient care decisions cannot be delayed.
The Advanced Life Support Patient Care Standards (ALS PCS) are intentionally structured to ensure that patient care is not compromised in these circumstances. As such, when a patch cannot be established, paramedics are expected to use sound clinical judgment to act in the patient’s best interest, while remaining within their delegated scope of practice and appropriately documenting and reporting the patch failure.
Where an intervention is included within the ALS PCS but normally requires a mandatory patch point, it is generally reasonable for paramedics to proceed after unsuccessful patch attempts, provided the clinical indication is appropriate, the intervention is time-sensitive, the risks and benefits have been considered, and the intervention would reasonably be expected to be authorized. Examples of this may include pediatric analgesia or synchronized cardioversion. This approach aligns with the intent of the ALS PCS, which is to support timely, patient-centred care even in the presence of communication barriers.
However, where an intervention falls outside the ALS PCS and would require a direct physician order beyond established medical directives, paramedics should not proceed solely due to patch failure. Patch failure does not expand a paramedic’s authority beyond their delegated scope. This includes situations such as administering medications not included in local protocols, managing specific toxicological exposures without an established directive, performing advanced procedures not outlined in the ALS PCS, or extending pediatric resuscitation care beyond defined standards. In these cases, paramedics are expected to provide the best possible supportive care within existing protocols and transport as appropriate.
Even in the event of a patch failure, paramedics continue to practice under delegated medical authority, not independent practice. When faced with these situations, paramedics should consider whether the intervention is within the ALS PCS, the urgency of the patient’s condition, and whether the intervention would reasonably be expected to be authorized, while also taking steps to mitigate risk such as independent double checks or partner consultation. All patch failures and subsequent clinical decisions should be clearly documented and reported through appropriate channels.
In summary, in the rare event of a true patch failure, paramedics are expected to act in the patient’s best interest using sound clinical judgment within the ALS PCS and their delegated scope of practice; this may include proceeding with time-sensitive interventions that normally require a patch, but does not extend to performing interventions outside established protocols or locally authorized medical directives.
For the purposes of clinical decision-making, a patch failure can be understood as an inability to establish contact despite reasonable and repeated attempts in a situation where patient care decisions cannot be delayed.
The Advanced Life Support Patient Care Standards (ALS PCS) are intentionally structured to ensure that patient care is not compromised in these circumstances. As such, when a patch cannot be established, paramedics are expected to use sound clinical judgment to act in the patient’s best interest, while remaining within their delegated scope of practice and appropriately documenting and reporting the patch failure.
Where an intervention is included within the ALS PCS but normally requires a mandatory patch point, it is generally reasonable for paramedics to proceed after unsuccessful patch attempts, provided the clinical indication is appropriate, the intervention is time-sensitive, the risks and benefits have been considered, and the intervention would reasonably be expected to be authorized. Examples of this may include pediatric analgesia or synchronized cardioversion. This approach aligns with the intent of the ALS PCS, which is to support timely, patient-centred care even in the presence of communication barriers.
However, where an intervention falls outside the ALS PCS and would require a direct physician order beyond established medical directives, paramedics should not proceed solely due to patch failure. Patch failure does not expand a paramedic’s authority beyond their delegated scope. This includes situations such as administering medications not included in local protocols, managing specific toxicological exposures without an established directive, performing advanced procedures not outlined in the ALS PCS, or extending pediatric resuscitation care beyond defined standards. In these cases, paramedics are expected to provide the best possible supportive care within existing protocols and transport as appropriate.
Even in the event of a patch failure, paramedics continue to practice under delegated medical authority, not independent practice. When faced with these situations, paramedics should consider whether the intervention is within the ALS PCS, the urgency of the patient’s condition, and whether the intervention would reasonably be expected to be authorized, while also taking steps to mitigate risk such as independent double checks or partner consultation. All patch failures and subsequent clinical decisions should be clearly documented and reported through appropriate channels.
In summary, in the rare event of a true patch failure, paramedics are expected to act in the patient’s best interest using sound clinical judgment within the ALS PCS and their delegated scope of practice; this may include proceeding with time-sensitive interventions that normally require a patch, but does not extend to performing interventions outside established protocols or locally authorized medical directives.