To provide a mechanism for EMT-Ps to be permitted to monitor pre-existing infusions of nitroglycerin and/or heparin during interfacility transfers.

AUTHORITY:

California Health & Safety Code, Division 2.5, Sections: 1798.200, 1798.206, 1798.214, 1797.218, 1797.220, 1798.2, 1798.170, and 1798.172.

California Code of Regulations, Title 22, Chapter 4.

POLICY:

Only those EMT-Ps who have successfully completed training program(s) approved by the S-SV EMS Agency Medical Director on nitroglycerin and heparin will be permitted to monitor them during interfacility transports.

Only those ALS Ambulance providers approved by the S-SV EMS Agency Medical Director will be permitted to provide the service of monitoring nitroglycerin and/or heparin infusions during interfacility transports.

Hospitals utilizing EMT-Ps to monitor nitroglycerin and/or heparin during interfacility transports will audit 100% of these calls.

Patients that are candidates for paramedic transport will have the following:

• Pre-existing heparin and/or nitroglycerin drips in peripheral or central IV lines.
  
• The heparin and/or nitroglycerin drip will have been running for at least 30 minutes prior to transport.
  
• Patients will be hemodynamically stable at the time of transport and will not have more that two medications infusions running exclusive of KCL.
  

PROCEDURE

1. The transferring hospital shall ensure the paramedic receives transferring orders from the transferring physician prior to leaving the sending hospital. These orders will include the following:
   

A telephone number where the transferring physician can be reached during transport.



Type of solution



Dosage and rate of infusion

1. The transferring hospital is responsible for mixing and labeling the nitroglycerin and/or heparin infusions. If the existing infusion will not be sufficient for transport, then the hospital must provide a pre-mixed infusion that is clearly labeled.
   
   
2. Transferring physicians must be aware of the general scope of practice of EMT-Ps and transport parameters outlined in Policy # 841.
   
   
3. 100% of calls will be audited by the transferring hospital. Audits will assess compliance with physician orders and regional protocols, including base contact in emergency situations.
   

CROSS REFERENCES:

Reference No. 841

Subject: Intravenous infusion of heparin &/or nitroglycerin during interfacility transfers

Reference No. 442

Subject: Intravenous infusion of heparin &/or nitroglycerin during interfacility transfers: application and approval process.

Reference No. 441

Subject: Intravenous infusions of heparin &/or nitroglycerin during interfacility transfers: service provider requirements & responsibilities