A2. In Phase 2 Paramedics will no longer have to wait to give a full triage report and room assignment before Hospital Transfer of Care (HTOC) occurs.

• Paramedics will provide a brief verbal report.
• TPS and hospitals have agreed that HTOC occurs once the verbal report and Fit2Sit Paramedic Report are provided to the triage nurse.
• Paramedics will be able to tactfully move to the front of the triage line to present their verbal report and Fit2Sit Paramedic Report to the next available triage nurse. This is designed to decrease triage delay.

A3. Yes. The Fit2Sit program does not eliminate any of the requirements set out in the BLS Patient Care Standards. Paramedics provide the required information in their brief verbal report with additional information being supplied in the Fit2Sit Paramedic report as well as the patient during their self-triage process.

A4. Not quite. Due to differences in physical layout and pre-triage expectations, the process will vary slightly at each hospital. In support, each hospital will have a specific Fit2Sit process poster located by the regular ambulance ED entrance. In addition, there is a QR code located on posters in the back of the ambulance and on the MobiCAD, as well as pocket reference cards that will provide Paramedics access to an electronic database that lists all participating hospitals and their associated Fit2Sit processes.

A5. Yes. TPS is working closely with the participating hospitals to communicate changes and expectations of Fit2Sit Phase 2. TPS will also be providing information sessions to the triage nurses at each site to ensure a clear understanding of the process.

A6. No. While Paramedics are not to interrupt a nurse if they are already actively triaging another patient, they may tactfully insert themselves ahead of others waiting for the next available triage nurse.  The verbal report and completed Fit2Sit Paramedic Report are designed to cause minimal interruption to the triage nurse and flow of patients in the emergency department.

A7. As long as the patient continues to meet the inclusion criteria/pertinent negatives, they are a candidate for the Fit2Sit program.

A8. Yes. During Phase 2 of the program, Paramedics should declare their patient as Fit2Sit when requesting a hospital destination.  The Patient Distribution System (PDS) will indicate to the hospital that the incoming patient is Fit2Sit. Hospital updates should continue to follow SOP 03.06.41 (Notification of Receiving Hospital) and are not typically required for CTAS 3-5 patients.

A9. When Fit2Sit Phase 2 launches, Paramedics will be assigned a hospital destination based on the current PDS rules. Paramedics may be assigned a hospital that has not yet launched Phase 2 of Fit2Sit as not all hospitals will be prepared to launch on the same date. Paramedics are to follow the Fit2Sit program (Phase 1 or 2) that is currently active at the hospital they are assigned to.

A10. The Fit2Sit criteria allows Paramedics to safely offload appropriate patients to the ED waiting rooms. The hospital is responsible for patients in their waiting room. Patients being offloaded to the waiting room must meet all Fit2Sit criteria.

A11. Paramedics will need to inform the patient of the Fit2Sit process prior to arrival at the hospital. This may need to be reiterated throughout the process to ensure the patient clearly understands what is happening. Adherence to Fit2Sit criteria will safeguard Paramedics from complaints regarding the patient’s final location in the ED. Paramedics are encouraged to contact a Superintendent if they have any concerns following a call.

A12. In Phase 2, HTOC occurs immediately after Paramedics provide the brief verbal report and Fit2Sit Paramedic Report to the triage nurse. Paramedic TOC (PTOC) should be declared immediately following this process.

A13. Fit2Sit empowers and supports Paramedics to make the decision to offload appropriate patients to the ED waiting rooms, and hospital staff are expected to be aware of this. If there is a disagreement between the Paramedic and the triage nurse, the Paramedic will stay with the patient and complete their regular triage process. Paramedics may have to move to the designated ambulance triage area if this differs from the location of the Fit2Sit Phase 2 triage area. Paramedics will document on their ePCR “patient meets Fit2Sit/not enrolled” and document the disagreement by the nurse in the section If not enrolled Fit2Sit. Reason?

A14. No. The MOH standards state that CTAS 3-5 patients must be transported “to and from the ambulance using the appropriate lift, carry or ambulatory assistance with respect to the situation, the patient’s clinical condition, or for patient comfort.”¹ This means that, if appropriate for the situation, a patient may remain ambulatory throughout the transport.

A15. Yes. TPS has a Quality Assurance program in place that was specifically designed for the Fit2Sit Phase 2 program which is overseen by TPS Professional Standards Unit.

A16. Currently we are working with all Toronto hospitals (EXCLUDING SickKids), to finalize this process. The participating sites will be confirmed when the “GO LIVE” date is announced.  TPS will launch Fit2Sit Phase 2 with the hospitals that are ready for the pilot. Other sites may join at later dates, once their hospital is ready. This is a collaborative initiative between Toronto area hospitals and Toronto Paramedic Services.

A17. No. Paramedics should follow the same standard of practice as with any other patient they treat. A blood sugar is not required for a Fit2Sit patient unless there is clinical evidence to support taking one.

A18. Yes. Several other services within the province are currently using a Fit2Sit program with great success. Not all Fit2Sit programs throughout the province are the same and not all have progressed to a program design where a patient can self-triage.

A19. We are working with our multimedia team to develop public messaging regarding the Fit2Sit program.