Establish Policy for the Transfer of Care of an Intubated Patients

Airway management is widely considered to be the most critical intervention in prehospital medicine.  Given the great deal of emphasis placed on airway management, it is imperative EMS organizations constantly review and improve upon airway management procedures.

During the recent Risk Control survey, it was noted that your organization provides non-transport advanced life support EMS in your primary response area.  Your firefighter/paramedics perform endotracheal intubation in the course of patient care.  During our conversation, it was mentioned the medical director for transporting EMS agency may prohibit their providers from performing endotracheal intubation.   It was noted that paramedics from your organization may not always accompany an intubated patient to the receiving facility.  Transferring the care of an intubated patient to a paramedic who does not have the authority to re-intubate the patient could increase liability for your agency.

We recommend that your organization establish a policy requiring the paramedic who intubates a patient in the prehospital environment to accompany that patient to the receiving facility in order to assure the patency of the airway until care is transferred to a medical provider equipped and prepared to fully manage the patients’ airway.  This policy should remain in effect until such time that all paramedics practicing for the transporting agency have been authorized to independently perform endotracheal intubation. 

Your organization should consult with your medical director to develop this policy.  Additionally, it is recommended that performance parameters are set in order to monitor compliance with this policy and assure proper documentation of care provided.