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A paramedic shall patch to the Base Hospital when:

  1. a medical directive contains a mandatory provincial patch point; OR
  2. an RBH introduces a mandatory BH patch point; OR
  3. for situations that fall outside of these Medical Directives where the paramedic believes the patient may benefit from online medical direction that falls within the prescribed paramedic scope of practice; OR
  4. there is uncertainty about the appropriateness of a medical directive, either in whole or in

In cases where a treatment option requires the prior authorization by the BHP (i.e. mandatory provincial patch point or mandatory BH patch point) AND the BHP cannot be reached despite reasonable attempts by the paramedic to establish contact, a paramedic may initiate the required treatment without the requisite online authorization if the patient is in severe distress and, in the paramedic’s opinion, the medical directive would otherwise apply. Clinical judgement must be applied and an acceptable standard of care must be met. This may be based on peer and expert review.  In such cases, a paramedic should continue attempts to contact the BHP after the treatment has been initiated.  All patch failures must be reported in a timely manner in accordance with local policy and procedures.  Paramedics should document the attempts to patch to the BH on the Ambulance Call Report (ACR).

If a BHP directs a paramedic to perform an assessment or intervention that exceeds the paramedic’s scope of practice, the paramedic must advise the BHP of such and notify the physician that he or she cannot comply with the direction as it exceeds his or her scope of practice. In such cases, a paramedic should ask the BHP to provide alternative direction.


Ministry of Health and Long-Term Care
5700 Yonge Street, 6th Floor
Toronto, ON M2M 4K5