FIELD REFERENCE
Full criteria & treatment guidance
Common triggers, not the full policy
- Contact is also appropriate whenever the patient would benefit. After contact, follow base orders. Use 310.00 and the applicable standing order for complete requirements.
Contact base when…
- The applicable standing order requires contact; do so before transport. Contact base when care beyond standing orders is needed.
- An adult is unstable without an applicable standing order: pulse below 50 or above 130, respirations below 12 or above 26, or systolic BP below 90.
- Specialty destination criteria apply, including stroke, trauma/replantation, burns, or cardiovascular receiving-center criteria.
- A patient requests refusal/AMA after an ALS procedure, or decision-making capacity/refusal criteria are uncertain.
- Field helicopter transport or MCI destination coordination requires contact; follow the policy’s MCI contact-point exception.
Children younger than 15
- A pediatric-capable base (CCERC) is preferred. Triggers include respiratory distress, circulatory compromise, BRUE (even resolved), arrest/ROSC, drowning, suspected assault, trauma, or burns.
- Without an applicable standing order, unstable pediatric thresholds include pulse below 60 or above 200, respirations below 12 or above 50, or systolic BP below 80.
Make the contact useful
- State the patient’s age, presenting problem, vital-sign trend, mental status, and why base contact is required. Include treatment and response when requesting further medical direction.
- For pediatric respiratory or circulatory compromise, a reported BRUE, arrest/ROSC, drowning, suspected abuse, or specialty destination needs, follow the pediatric contact provisions even if a symptom has resolved.
Standing orders & subsequent care
- Standing orders apply to on-duty OCEMS-accredited paramedics working for approved providers. Need for treatment beyond the standing order calls for further online medical direction.
- After base contact, follow base orders. If contact is discontinued, 310.00 allows resuming the appropriate standing order.
- PR-230 effective April 2026 removes the adult push-dose epinephrine order/contact requirement for that procedure. PR-205 still requires a pediatric order; the two pathways must not be conflated.
UNDERSTAND THE CARE
How to make the medical-control decision clear
Base contact can be required by the patient’s condition, a proposed treatment, a destination decision or a refusal situation. Identify which requirement applies instead of treating every call as a request for medication permission. Some procedures allow treatment without a base order while the condition still requires contact for another reason.
Applying the guidance
A useful report presents the problem that base needs to help resolve. Include age, relevant findings, trends and the response to care already delivered, then state the question or requested direction. For children, use the pediatric provisions and preferred pediatric-capable base. A symptom that has resolved can still meet a historical-event trigger, including the listed BRUE circumstances.
Putting it together
Teaching example: a child is comfortable when examined after a reported concerning resolved event. Report the event history and current assessment separately; do not erase a historical contact trigger because the current vital signs look reassuring.
Diagram text & teaching checkpoints
- Condition
- Does the presentation require contact?
- Treatment
- Is additional authority or direction needed?
- Destination or refusal
- Does the transport decision trigger contact?
- Report
- State findings, care, response and the decision needed.
Sources for this explanation
Original OCMedic teaching synthesis of the references below. Educational expansion updated ; this is not a new independent clinical-review date. Source-specific dates and limitations remain in the full guidance.
Build a focused base report
A useful report separates the reason for contact from the decision requested. For example, a specialty-destination discussion and a request for care beyond a standing order are different questions, even when both apply to the same patient.
- State the trigger: name the condition, standing-order requirement, destination concern or refusal problem.
- Describe the trend: give the initial and current relevant findings, treatment already delivered and response.
- Ask the question: specify the additional direction or destination decision needed.
- Record the answer: document the direction received and communicate it to the transporting crew.
Teaching example: a patient improves after an authorized intervention but still meets a specialty destination trigger. Report the improvement and the continuing destination question separately. Do not confuse permission to begin a procedure with the independent need to contact base or provide ALS escort. Policy 310.00 contains distinct sections for each decision.
OCEMS source: 310.00: 9-1-1 Advanced Life Support Base Contact, Standing Order, and Transport Criteria.