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G03: IFT of the Behaviourally Compromised Patient
Christopher Mistiades
Updated:
Reviewed:
Introduction
Interfacility transfer of a behaviorally compromised patient by paramedics involves a unique set of challenges. Paramedics need to be prepared for potential agitation, unpredictable behavior, and the need for specialized interventions during transport. Proper planning, communication with the sending and receiving facilities, and understanding of relevant legal frameworks are crucial for ensuring a safe and effective transfer.
Essentials
- Confirm patient identity and obtain clinical handover report
- Ensure patient, caregivers, and family are treated with respect and dignity
- Confirm supporting documentation is complete
- Determine if a family member can be accommodated during transport, based on space and clinical status. (Low risk patients only)
- Involve the patient and patient's family in decision making process when possible.
- Use a calm and reassuring tone of voice and avoid sudden movements or loud noises.
- Use an open body posture and stance with arms uncrossed , shoulders back and head held high. Maintain eye contact with an engaged facial expression.
- If medications are needed for sedation or to manage agitation, ensure they are administered in accordance with medical direction and the patient's Individualised Transport Plan
- Ensure pre-transport medications have desired therapeutic before initiating transport.
Referral Information
Interventions
Emergency Medical Responder (EMR) & All License Levels Interventions
- Evaluate the patient's clinical status
- Correct or continue treatments where required
- Evaluate assessment findings in relation to information provided by dispatch
- Evaluate need for mechanical restraints if not part of Individualised Transport Plan.
- If Individualised Transport Plan does not align with transport needs, patient or safety
Consult CliniCall Hub (PS, CCP-A, ITT-A, EPOS) for re-conference
- During transport, ensure the patient is safely secured in the ambulance and that the vehicle is equipped for the patient's needs.
- During transport, conduct continuous monitoring and reassess the patient's condition.
- Intervene for clinical changes and risk assessment as needed during transport.
- Thoroughly document all assessments, interventions, and changes in the patient's condition during the transport.
Primary Care Paramedic (PCP) Interventions
- Confirm Individualised Transport Plan falls within PCP scope of practice
- Administer medication during transportation as described within the Individualised Transport Plan and only for the purpose of maintenance of therapy.
Advanced Care Paramedic (ACP) Interventions
- Confirm Individualised Transport Plan falls within ACP scope of practice
- Consider cardiac monitoring where required:
- Administer medication during transportation as described within the Individualised Transport Plan for the purpose of maintenance of therapy.
- Treat manifestations of behavioural emergency that fall outside the Transport Treatment Plan as appropriate:
- ☎️ CliniCall consultation required if appropriate pharmacological restraint not achieved with maximum single or maximum cumulative dose of medications AND for all patients < 12 years of age prior to administration
- When sedation or pharmacological restraint is applied as part of, or in addition to that outlined in the Individualised Transport Plan:
- Monitor oxygenation and ventilation closely during transport,
- Do not withhold BVM ventilations to a patient who requires ventilatory support.
Critical Care Paramedic (CCP) Interventions
- Participate in Pre-transport and sedation conferencing where necessary.
- For a severely agitated patient, who in accordance with an agreed upon Individualised Transport Plan has been sedated and intubated for transport by the sending facility: