Ala. Admin. Code r. 420-2-1-.24

Current through Register Vol. 43, No. 1, October 31, 2024

Section 420-2-1-.24 - Patient Transfers

(1) No person or facility of any type shall order, arrange, or conduct a transfer of a patient in a recumbent position by ground or air ambulance unless transport of the patient is done by an emergency medical provider service licensed by the Board in an ambulance permitted in accordance with the level of care (ALS or BLS) the patient needs, or is likely to need, during transport. Each ambulance transporting patients between facilities shall have, in addition to a driver or pilot, at least one EMSP licensed at a level which will allow the EMSP to provide the care the patient needs or is likely to need. The provider service medical director is responsible for assuring, in advance, that the ambulance and EMSP have the capability to meet the patient's expected needs. The transferring physician will ensure that the level of patient care, staffing, and equipment during transport is appropriate to meet the current and anticipated needs of the patient.

(2) The transferring hospital should provide a complete medical record or patient chart to the receiving hospital. The emergency medical provider service operator shall ensure that a complete and accurate patient care report, as prescribed by the Board, is submitted for each transfer.

(3) In addition to the fluids and medications which a paramedic may administer to an emergency patient, they may administer, perform, and maintain other types of I.V. fluids and medications during the transfer of a stabilized patient on the signed, written order of the transferring physician given to a paramedic in advance. The following conditions apply:

(a) The patient shall be deemed by the transferring physician to be appropriately stabilized to permit transport to another healthcare facility by the mode of transport selected.

(b) The transferring physician shall have communicated to a paramedic all necessary aspects of patient management and the administration or maintenance of specified fluids, medications, equipment, and procedures that would be administered or maintained during transport.

(c) During transfers, a paramedic may be authorized to administer or maintain infusion of the classification of fluids and medications, perform procedures, or maintain equipment identified herein only after successful completion of the continuing education course of instruction approved by the State Board of Health entitled, "Administration and Maintenance of Fluids, Medications, Procedures, and Equipment during Inter-hospital Transfer of the Stabilized Patient," and have in his or her possession documented evidence issued by the OEMS attesting to the completion of such training. In addition, the service medical director, regional medical director, and SEMCC shall approve, in writing, specific medications under each general classification. This written approval shall be on file with the transferring institution and the OEMS, and shall be renewed annually.

(d) The specific classifications of I.V. fluids and medications which a paramedic is authorized to administer or maintain are strictly limited to the following, or their generic equivalents, for administration or maintenance only in the dosages, forms, frequency, and amounts as ordered in writing, in advance, by the transferring physician:

1. Vitamin, mineral, and electrolyte infusions.

2. Central nervous system and neuromuscular agents.

3. Anticonvulsants.

4. Antipsychotics, anxiolytics, antidepressants.

5. Anti-infective agents.

6. Antineoplastic agents.

7. Respiratory agents.

8. Cardiovascular agents.

9. Gastrointestinal agents.

10. Endocrine and ophthalmic agents.

11. Reproductive agents.

12. Circulatory support agents.

(e) Administration of thrombolytics by paramedics will be administered by established Alabama EMS Patient Care Protocols.

(f) The specific invasive procedures and equipment which a paramedic is authorized to administer or maintain during transfers are strictly limited to the following as ordered in writing, in advance, by the transferring physician:

1. Portable Ventilators.

2. Chest Tubes.

(g) A written order, signed by the transferring physician containing the following elements of information, shall be completed and delivered to the receiving hospital with the patient:

1. The patient's name and diagnosis.

2. The name and signature of the transferring physician.

3. The name of the transferring hospital.

4. The name of the paramedic accepting the patient for transport.

5. The name of the receiving physician.

6. The name of the receiving hospital.

7. The date and time the patient was released by the transferring physician.

8. The date and time the patient was accepted by the receiving physician.

9. All fluids and medications administered or maintained or both.

10. Specific medical orders and detailed prescriptions clearly specifying dosages and frequency.

11. All required life support equipment the patient needs or is likely to need.

12. Other remarks as appropriate related to patient management.

13. Patient's personal belongings should be signed off for by the patient's family when given details of the patient to the receiving hospital. If no family is available, they should be signed off for by the staff at the receiving hospital.

(h) All medications required by the transferring physician to accompany the patient or medications which are already infusing should be supplied by the transferring hospital. All medications provided for use during the transfer together with all unused medications, syringes, vials, or empty containers shall be accounted for by the paramedic in the same manner in which the transferring hospital would normally do so or require.

(i) Documentation shall account fully for all medications administered or maintained during transfer.

(j) All medications authorized to be administered or maintained during inter-hospital transfers shall be stored, managed, and accounted for separately from those in the normal paramedic's medication container for pre-hospital emergency care.

(4) The requirements of this rule and other requirements of these rules do not apply to vehicles operated by a hospital exclusively for intra-hospital facility transfers. To qualify for this exemption, a vehicle shall conform to all of the following requirements:

(a) The vehicle shall be used exclusively for the transport of patients from one facility in a licensed hospital to another facility in the same licensed hospital. The vehicle shall not be used to respond to emergencies, to transport emergency patients, or to transport patients for any purpose other than intra-hospital facility transfers.

(b) The hospital shall be licensed by the Board and licensure records shall be on file with the Department's Bureau of Health Provider Standards.

(c) Each building from which patients are sent or by which patients are received shall be operated by the licensed hospital, as documented in the hospital's licensure records. Patients sent from a facility operated by one licensed hospital to a facility operated by another licensed hospital will be considered inter-facility and NOT intra-facility transfers, regardless of whether the licensed facilities are owned or operated by the same entity.

(d) All crew members on board the vehicle shall be hospital employees.

Ala. Admin. Code r. 420-2-1-.24

Filed September 1, 1982. Repealed and Replaced: Filed September 20, 1996; effective October 24, 1996. Amended: Filed March 20, 2001; effective April 24, 2001. Repealed and New Rule: Filed December 17, 2007; effective January 21, 2008. Repealed and New Rule: Filed April 20, 2011; effective May 25, 2011.

Amended by Alabama Administrative Monthly Volume XXXV, Issue No. 06, March 31, 2017, eff. 4/30/2017.

Adopted by Alabama Administrative Monthly Volume XXXVII, Issue No. 05, February 28, 2019, eff. 4/7/2019.

Adopted by Alabama Administrative Monthly Volume XXXVIII, Issue No. 07, April 30, 2020, eff. 6/14/2020.

Adopted by Alabama Administrative Monthly Volume XL, Issue No. 05, February 28, 2022, eff. 4/14/2022.

Rule .07 was renumbered .16 and original Rule 420-2-1-.16,Responsibility For Patientwas repealed as per certification filed April 20, 2011; effective May 25, 2011. Rule 420-2-1-.16 was renumbered 420-2-1-.24 as per certification Filed February 20, 2019; effective April 7, 2019.

Authors: William Crawford, M.D.; Jamie Gray

Statutory Authority:Code of Ala. 1975, § 22-18-1, et seq.