Current through Register Vol. 42, No. 5, February 29, 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.
(4) The requirements of this rule
and other requirements of these rules do not apply to vehicles operated by a
hospital exclusively for intra-hospital facility transfers. To qualify for this
exemption, a vehicle shall conform to all of the following requirements:
(a) The vehicle shall be used exclusively for
the transport of patients from one facility in a licensed hospital to another
facility in the same licensed hospital. The vehicle shall not be used to
respond to emergencies, to transport emergency patients, or to transport
patients for any purpose other than intra-hospital facility
transfers.
(b) The hospital shall
be licensed by the Board and licensure records shall be on file with the
Department's Bureau of Health Provider Standards.
(c) Each building from which patients are
sent or by which patients are received shall be operated by the licensed
hospital, as documented in the hospital's licensure records. Patients sent from
a facility operated by one licensed hospital to a facility operated by another
licensed hospital will be considered inter-facility and NOT intra-facility
transfers, regardless of whether the licensed facilities are owned or operated
by the same entity.
(d) All crew
members on board the vehicle shall be hospital employees.
