Paramedic Referral Guidelines

Empower Advanced Care Paramedics outside of LARU to make safe clinical decisions on non-transportation or referral by providing clinical practice guidelines for common low risk presentations where transport to ED is inappropriate. This has been implemented in Ambulance Victoria as “Treat and Refer” guidelines assisting paramedics to make clinical decisions on referral to other services for common presentations including back pain, epistaxis, suspected gastroenteritis, etc. Guidelines are written to avoid high risk patient groups and to screeen for high risk clinical features. This potentially allows frontline regular paramedics to safely refer patients and provide standardised clinical advice. Further research may be required to assess safety and impact.

Why the contribution is important

Speaking with colleagues there is a real fear of leaving patients at home with potential complications particularly within the context of registration. From observation and discussion many paramedics are uncertain on who can be safely left at home - either over-estimating potential adverse effects, or underestimating the risk in some patient groups. Providing guidelines to assist with (not replace) clinical decision making may improve the confidence of frontline paramedics in making a decision to not transport to ED and finding appropriate referral services, without relying heavily on consult lines. This may reduce conveyance rates and improve safety.

by Kchalmers on August 12, 2019 at 11:44AM

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Comments

  • Posted by nurse11 August 14, 2019 at 07:59

    I am fairly sure this kind of thing already happens. I know within the diabetes world, we can receive QAS referrals from people they haven't transported and require follow-up.
  • Posted by Pjhill August 19, 2019 at 09:07

    A great idea and totally agree with the concerns raised by paramedics.
  • Posted by TrentWheeler August 21, 2019 at 16:34

    QAS paramedics now have a Clinical Practice Manual that includes guidelines for many high acuity conditions which we will likely never encounter, but the presentations that we encounter daily that are the subject of this discussion have either no guideline at all, or a guideline that makes blanket statements mandating transport.

    Respiratory tract infections, gastroenteritis, non-traumatic back pain, migraines, abdo pain where the cause is known (eg. gallstones, kidney stones, diverticulitis, constipation), hypertension, hyper- or hypoglycaemia, joint or chronic injury pain...all conditions that are seen daily that paramedics are given no training regarding how to appropriately assess and risk stratify, and how to manage without involving an ED.
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