Can an ACP begin pain management on a PCP crew's patient at the hospital?

Is an ACP authorized to provide opiate based analgesia to a patient in the care of a PCP crew after their arrival to the ED? For example, if a PCP crew brings a patient in Sickle Cell crisis to the ED, and there is a prolonged period of time before they are able to triage and offload, can an ACP that is present in the ED assume care for that patient, establish an IV and administer Fentanyl; provided that they are added to the PCR and remain with the patient until they are offloaded to the ED and a report is given to the receiving staff?

The straightforward answer is no, not routinely. This is not the preferred approach.

Once a PCP crew arrives at the emergency department, concerns about uncontrolled pain should first be escalated to hospital staff. The crew should advocate for timely triage, an appropriate treatment space, and hospital-directed analgesia.

In exceptional circumstances, where these efforts have been exhausted and the patient continues to experience significant pain, an ACP who is present may be able to formally assume care of the patient and patch to a base hospital physician for direction. This could include establishing intravenous access and administering fentanyl if specifically authorized.

The ACP would need to be added to the patient care record, remain with the patient, continue all required assessments and monitoring, and provide a complete transfer-of-care report to the receiving hospital staff.

This approach must also be reviewed with the paramedic service, as local policies may restrict or define crew-to-crew transfers of care within a hospital. In general, this practice should be discouraged and reserved for exceptional circumstances. The emergency department should be responsible for addressing the patient’s pain in a timely manner.