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

1. 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):

• Termination of Resuscitation (TOR)
• Amiodarone, lidocaine, or adenosine (monomorphic wide complex regular rhythm) authorization
• Synchronized cardioversion authorization
• 0.9% NaCl fluid bolus for hypotensive patients (≥2 years)
• Pediatric (<12 years) opioid analgesia (morphine or fentanyl) authorization and dosage verification
• Release from care (COVID-related)
• Hydroxocobalamin administration for suspected cyanide toxicity

Additionally, paramedics must patch:

1. When a medical directive includes a mandatory provincial patch point

2. Verbal Order

1. 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.