EMS Offload Policy

Section 1 - ADMINISTRATIVE POLICIES

1.16 EMS OFFLOAD POLICY

It is essential that the Maitland paramedic arriving at a hospital work aggressively to off-load the patient as soon as he or she enters the hospital. Paramedics must verify hospital status prior to determining transport destination by utilizing the MDC or contacting the Comm. Center. If a hospital is categorized as Red (delayed off-load), diversion from the hospital shall be made. Exceptions to that shall be due to the patient’s condition or for patient request (physician, previous procedure, etc.)

Paramedics are to make a determination of whether or not the patient is stable enough to be moved to the triage area. If patient is able to be transferred to a wheel chair or waiting room chair, this shall be done with a written/verbal report to the triage nurse. If resistance with this is encountered, contact the on-duty Battalion Chief.

Obvious delay

• Upon arrival at an ED with an obvious delay (i.e. multiple rescues/ambulances waiting) call the on-duty Battalion Chief immediately. **Follow timeframes below**

Not an Obvious Delay

• Upon a delay in offload make the first call at the 30 minute mark to the on-duty Battalion Chief. Ensure to have the name and contact information of the charge nurse. Battalion Chiefs are to contact the charge nurse to determine an offload timeframe. If offload is determined to be imminent (within 5 mins) the Battalion Chief will advise the crew and follow-up to confirm offload. If the offload is determined to be longer than 5 mins the Battalion Chief will contact the Nurse Manager or Assistant Nurse Manager to apprise them of the situation. Once the 45 minute mark is achieved the Battalion Chief shall contact the Deputy Fire Chief. The Deputy Chief will contact the Director of Nursing. At the 60 minute mark the Deputy Chief shall contact the Fire Chief for further notifications.

• The following patients have been identified as unstable or potentially unstable by the Medical Director and MAY NOT be left unattended:
  • Chest pain
  • Unresolved shortness of breath
  • Decreasing neurological status
  • Decreased level of consciousness due to medication given by EMS
  • Suspected Abdominal Aortic Aneurysm (A.A.A.)
  • Gastrointestinal (G.I.) bleed
  • Active labor
  • Severe uncontrolled pain
  • Ectopic pregnancy
  • Uncontrolled bleeding
  • Abruptio Placenta or Placenta Previa