PIFT REFERENCE SHEET

Transcription

1 PIFT REFERENCE SHEET The following reference is used to determine whether a patient meets the stability criteria for transfer under the PIFT guidelines. If they do not meet the criteria the hospital needs to send appropriate staff with the patient. Key Point: The cornerstone of PIFT is patient stability. PIFT is based on the premise that the PIFT paramedic is caring for a single, stable patient while alone in the back of the ambulance. Patient stability guidelines are listed below. (1)Stable Low Risk Patient: A patient who has hemodynamic and neurological stability with no foreseeable deterioration. This is the patient who is not suffering from an acute illness but has medications or interventions being administered which are outside the scope of the paramedic without PIFT training. Example: patient going to MRI with an OG/NG tube on suction. (2)Stable Moderate Risk Patient: A stable moderate risk patient is one who has hemodynamic and neurologic stability from therapies initiated. Therapies initiated must be expected to maintain patient stability during the transport. This patient is typically going via emergent transfer to a tertiary facility for service not readily available at a local facility. Variation on existing therapy has demonstrated no deterioration and may be reasonable predicted to remain with change during the transport without the need for further adjustments to such therapy. Example: Patient who initially presented with syncope, chest pain and Bradycardia, was treated with a transcutaneous pacemaker and has been pain free with stable vitals since placement. (3)Unstable High Risk Patient: The patient is NOT hemodynamic and/or neurologically stable or has interventions outside the scope of PIFT. Example(s): Patient is intubated, patient has not responded to interventions, patient is at risk of deterioration during transport or patient cannot be managed by one paramedic in the back on the ambulance. Key Point: Adding more EMS personnel does not meet the PIFT guidelines. If the patient is found unstable by your assessment or you are not able to manage the patient as a single provider you need to request appropriate staff, i.e. RN or RT from sending hospital. Outlying facilities may consider utilizing Life Flight of Maine.

2 PIFT Medication Classifications List includes general class or grouping of drug followed by smaller class or drug found in that classification. 1. Anticoagulants: a. Actively running Thrombolytics are NOT included 2. Anticonvulsants: a. Benzodiazepines b. Barbiturates c. Dilantin/Cerebryx 3. Antidiabetics a. Insulin 4. Antidysrhythmics a. Beta Blockers b. Calcium Channel Blockers c. Cardiac Glycosides d. Miscellaneous Antidysrhythmics such as Amiodarone etc. 5. Antihypertensives: a. ACE Inhibitors b. Beta Blockers c. Alpha Blockers d. Calcium Channel Blockers e. Diuretics f. Vasodilators 6. Anti-Infectives: a. Antibiotics b. Antivirals c. Antifungal agents 7. Antipsychotics 8. Cardiac Glycosides 9. Coricosteroids 10. Drotecogin (Xigris)

3 11. Gastrointestinal Agents: a. Protein pump Inhibitors b. Somatostatin Analogues c. H2 Blockers d. Anti-emetics 12. IV Fluids: a. LR, NS, D5W, D10W, Dextran, Plasmanate, Hetastarch, Albumin b. Electrolytes 13. Narcotics/Analgesics: a. Does NOT include Anesthetics such as Etomidate or Propofol 14. Parenteral Nutrition & Vitamins 15. Platelet Aggregation Inhibitors (including IIb/IIIa Inhibitors) 16. Respiratory Medications: a. Beta Agonists b. Anticholinergics c. Steroids d. Mucolytics e. Miscellaneous such as Aminophylline or Montelukast 17. Sedatives: a. Narcotics b. Benzodiazepines c. Antipsychotics d. Barbituates e. Does NOT include Anesthetics such as Etomidate or Propofol 18. Vasoactive Agents: a. Vasopressors/Sympathomimetics b. Nitrates c. Vasodilators 19. Over the Counter Medications 20. Other Prescription Medications: a. Patients regular prescription medications.

4 PIFT Devices: 1. Infusion Pump a. If medication is part of the normal Maine EMS scope of practice (i.e., amiodarone drip) it needs a paramedic to transport but does not qualify as a PIFT run. 1. Lewiston/Auburn Base needs to switch to the United infusion pump 2. Bridgton Base can use Bridgton Hospital infusion pump b. If medication in the pump is outside of normal Maine EMS scope of practice but under the PIFT list then it qualifies as a PIFT call. NOTE: If the medication is part of the normal scope of practice BUT is delivered in a way that is not approved in the field it qualifies as a PIFT. (i.e. Sodium Bicarb, we carry as a bolus but do not hang drips so a patient with a Sodium Bicarb drip would be considered a PIFT call.) 2. Continuous Bladder Irrigation (CBI) a. Simple Foley Catheters may be transported by Basic level up 3. Central Lines PIFT only if medication running a. Central Lines without meds can be transported by Basic level up 4. Tranvenous Pacers 5. Chest Drainage - PIFT if patient has a chest tube either on suction or gravity a. Heimlich Valve may be transported by Basic level up 6. OG/NG tube PIFT only if attached to suction a. Capped OG/NG tube may be transported by Basic level up 1. Patient Centric versus special devices Other Devices: *If the patient is the one responsible for the medication or device any level can transport 2. Non-medicated Intravenous fluid: a. Can be transported by Basic with IV maintenance or above

5 3. PCA pumps: a. Can be transported by Basic with IV maintenance or above if patient triggered. b. Becomes a PIFT if Paramedic activated or has continuous infusion that requires Paramedic intervention and or management. NOTE: Clarified by MDPBpatients who have a PCA with an underlying continuous infusion (i.e. morphine with a 4 mg an hour set rate) is still a patient centric device and can be transported by Basic with IV maintenance or above. 4. G tubes, J tubes, PEG Tubes: a. Can be transported by any level 5. Epidural pumps: a. Not a PIFT device if used in acute setting b. Patients with chronic pain may have implanted epidural or intrathecal pumps and can be transported by any level per MDPB Home Devices Stance 2007 Non PIFT Devices: 1. Ventilators or Intubated patients: a. Cannot be managed by one Paramedic b. Requires Respiratory Therapist or other as deemed appropriate by sending facility 2. Balloon Pump a. Indication of an unstable patient. 3. LVAD a. When sent as interfacility transport needs additional Hospital personnel 4. Any infusion medications used to sedate or paralyze a patient a. (i.e. Versed/Fentanyl/Propofol/Etomidate). 5. Other Devices as identified as outside the scope of PIFT Revised: July 27, 2010/ead