Bonner County EMS SystemOperational Guidelines
Medico-Legal: Authorization to provide Non Emergent Transfers (NETS)-1056
Authorization to provide NETS
NON-EMERGENCY TRANSFER GUIDELINES
A. EMS providers may be called to provide non-emergent, transfers (NETS) of patients
who because of medical reasons, cannot or should not be transferred safely by
private transportation.
B. The purpose of these guidelines is to establish parameters for transfer and treatment,
and to maintain the continuity of care of both stable and unstable patients.
C. Types of non-emergency transfers.
1. Nursing care facilities to hospital or medical offices and return.
2. Immediate care/ urgent care facility to hospital/ emergency room.
3. Hospital to hospital generally for higher level of care.
4. Home to hospital or medical office for scheduled care, when medically
necessary to transfer by ambulance.
D. NETS will be categorized by the level of care required
1. BLS: No invasive equipment or monitoring except basic vital signs. Only
oxygen can be used and no IVs.
2. ILS: Can have IVs running (NS, D5W, D51/2 NS, LR), or lock (NS or
heparin). Can have oxygen, but no other medications running, and no new
medications for the prior 30 minutes.
3. ALS: Can have IVs running (NS, D5W, D51/2 NS, LR), or lock (NS or
heparin). Medications can be running if within current Idaho EMSPC scope
of practice and provider training, and up to two IVs running on pumps.
Specifically, nitroglycerin, heparin and dopamine (if not being actively
titrated) can be utilized. Patients can have cardiac monitoring, can be
intubated, and ventilators managed only if within the scope of practice and
training for the EMS Provider. Patients may require deep suctioning.
4. Certain situations inappropriate for NETS and requiring CCT (1057) include:
a. Administration of blood, second dose of antibiotics, Eptifibatide (Integrelin), Dobutamine, and Nitroglycerin and Dopamine when titrated
- Ventilator patients or airway when changes are expected or needed
- IV pumps with more than two channels or drugs running at once
- Patients who are unstable with high chance of deterioration
E. Exclusions of non-emergent transfers.
1. Caller requests emergent transfer for any reason.
2. Patient has a serious life-threatening diagnosis such as acute Stroke or Acute
Myocardial Infarction and requires transfer to a center for a higher level of
care. These patients require Critical Care Transport (CCT), Guideline (1057).
- Caller desires transfer to medical office or hospital for convenience rather than a validmedical reason for requiring EMS assistance.
E. There clearly exists a category of patients who require urgent but not emergent
transfer. These patients may require urgent attention, but may be stable and not
require ALS management en-route. If care is needed urgently, these should be
treated and managed like any 911 call.
- Patients with fractures identified at urgent care facilities where a higher level of care (such as surgery) is required.
- Patients presenting at medical offices with symptoms requiring non-emergent hospitalization, but unable or unsafe to make the journey by private means.
- Patients presenting with gradual deterioration at nursing homes requiring urgent hospital evaluation, but not requiring ALS services.
RESPONSIBILITY FOR CARE/ REGULATIONS
A. Under these guidelines, the health and well being of the patient must be the
overridingconcern when any patient transfer is considered.
B. How and when a patient is transferred, rests mainly on the sending institution and the
physician(s) directly in charge in the care of the patient.
C. Physicians, as well as hospitalsand other medical facilities must follow strict
guidelines when a transfer of a patient is“indicated”. These guidelines, provided
under provisions of the Consolidated OmnibusBudget Reconciliation Act (COBRA),
and the Federal Emergency Medical Treatment and Labor Act (EMTALA) dictate
how, and when a patient should betransferred, assuring a medical evaluation is
completed and other guidelines have beenfollowed according to the law.
Assessment Prior to Transfer
A. It is important to ensure within reasonable medical probability that no material
deterioration of the condition is likely to result from or occur during the transfer.
1. If the patient is unstable, then they first must be stabilized within the
emergency treatment capacity of their current facility.
- The transfer service must havethe appropriate staff and equipment available
to complete the transfer safely.
B. If a patient’s condition is likely to deteriorate while in transit, but is relatively certain
todeteriorate if there is not a transfer, and the patient has been treated to the highest
level ofcare at the sending facility, then the benefits of transfer outweigh the risk of
non-transfer. This patient however will require Critical Care Transport (CCT).
C. The transfer provider must ensure the following:
1. Obtain report on patient, verify orders, (obtain copy of drug order if not on
license), and document reasons for transfer.
2. Adequate personnel and equipment are available to transfer the patient safely.
3. Collect all relevant records to provide to the receiving facility.
4. Establish and evaluate adequacy of airway, ventilation and oxygenneeds.
5. Assess need for any extremity or spinal immobilization.
6. Assess vital signs on all patients. If unstable, please discuss readings
with patient’s nurse/physician, and reassess adequacy of staff and equipment
for transfer, or whether further stabilization may be required prior to transfer.
- Establish and/or maintain adequate access routes (IV) for fluid/drug
administration. Check for patency and document fluid type, etc. (if indicated).
8. Determine if EKG or oxygen saturation monitoring will be necessary.
9. Determine if restraints will be necessary (Patient Restraint -1036).
Considerations during Transfer
A. If the patient’s condition deteriorates en-route, the most senior EMS provider shall
determine if the patient should be transported to the closest medical facility, or
continue to complete thetransfer to the planned receiving facility.
1. Administer appropriate care and treatment via established guidelines, and
contact Medical Control as necessary and indicated by guidelines.
2. All possible BLS and ALS care SHALL be rendered to the patient, when
appropriate for sudden changes in condition.
B. Monitor all vital signs en-route, document and treat any changes, as indicated.
C. Upon arrival of the receiving institution, give report on the patient to appropriate
staff. Transfer over any medications on pumps, correct drug dosage, monitor, etc.
D. If receiving facility is a freestanding diagnostic testing center, and if these facilities
do not have the appropriate staff and/or equipment to handle the patient, then
the EMS provider should maintain care and stay with the patient until the receiving
facilitycan provide appropriate care.
E. If transferring to a facility, a copy of the PCRshould be left with the facility to
become part of the patient’s medical record.
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BCEMS Medical Director
Effective: 04/01/14final 9/28/2018 page 1of 3