BHP Support Document: Patch Call Definitions and Mandatory Patch Points
Purpose:
This provides clear definitions to support Base Hospital Physicians (BHPs) in understanding and responding to patch calls from paramedics. Multiple types of patch interactions may occur in a single call. BHPs should select all applicable types when documenting.
Patch Call Definitions
1.Mandatory Patch
- A Mandatory Patch is required under the Advanced Life Support Patient Care Standards (ALS PCS) when specific clinical scenarios are encountered. These patches ensure medical oversight for high-risk interventions or decisions.
Mandatory Patch Situations (ALS PCS):
Below are a list of mandatory patch points found in the ALS PCS
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TOR (Termination of Resuscitation)
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Patch to BHP for authorization to proceed with amiodarone or lidocaine or if monomorphic wide complex regular rhythm for adenosine.
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Patch to BHP for authorization to proceed with synchronized cardioversion.
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- Termination of Resuscitation (TOR)
- Amiodarone, lidocaine, or adenosine (monomorphic wide complex regular rhythm) authorization
- Synchronized cardioversion authorization
- 0.9% NaCl fluid bolus
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- for hypotensive patients
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- (≥2 years)
- Pediatric (<12 years) opioid analgesia (morphine or fentanyl) authorization and dosage verification
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Patch to BHP for authorization to administer 0.9% NaCl fluid bolus to hypotensive patients ≥2 years
- Release
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- from care (COVID-related)
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- Hydroxocobalamin administration for suspected cyanide toxicity
A paramedic shall patch to the Base Hospital whenAdditionally, paramedics must patch:
- When a ) a
- medical directive contains
- includes a mandatory provincial patch point ; OR
- b) for situations that fall outside of these Medical Directives where the paramedic believes the patient may benefit from online medical direction that falls within the prescribed paramedic scope of practice; OR c) for consultation when, in the paramedics opinion the patient presentation or situation warrants and medical advice is required
- For clinical circumstances outside the directives, but within the paramedic’s scope, where online medical direction could benefit patient care
- When clinical consultation is warranted by the paramedic’s judgment
2. Verbal Order
- A Verbal Order is a request for a delegated medical act not currently as standing order in ALS-PCS (e.g., pediatric analgesia (Tylenol and Advil), IV fluids (normal BP)), but still within the paramedic’s scope of practice. Paramedics must be trained and feel competent in performing the act. Examples include:
- Pediatric analgesia (Tylenol and Advil)
- IV fluids for patient with normal BP
3. Clinical Advice
Clinical Advice involves BHPs providing guidance that does not include a delegated act. This may include:
- Capacity with complex Against Medical Advice cases
- Alternative approaches to a non delegated act
- Clarification on directives or general clinical questions
4. Training Patch
A Training Patch is part of a scheduled educational session organized by the Base Hospital or a paramedic service. It involves simulated case scenarios that require a patch, but no real patient is involved. This does not include calls from student paramedics during actual patient care—those are considered real clinical interactions.
Important Note:
These patch types are not mutually exclusive and may occur together in a single call. For example, a call may simultaneously include:
- A Mandatory Patch for synchronized cardioversion
- A Verbal Order for medication adjustment
- A request for Clinical Advice about post-intervention care
Documentation:
BHPs should clearly identify and document all applicable patch types (e.g., Mandatory Patch, Verbal Order, Clinical Advice, Training Patch) during each call. Accurate classification supports proper record-keeping, quality assurance, and comprehensive reporting for the OMC Program.