There is a small bit of intelligence built into the MICN/Base Hospital contact system... usually. There usually is a provision where if you cannot make base contact, you may implement those orders that you would otherwise make contact to get permission to implement. You then generally have to advise the base hospital of what you did once you're able to make contact and write a report about what happened and as long as it's something you didn't create (like forgetting the radio or cell phone in the truck) all is good... if you can justify why you did the "extra" stuff.
Back when I last worked in Sacramento County (oh, so long ago...) there also was an odd provision whereby interfacility providers could enter into an agreement with the county to utilize the entire protocol manual in an off-line manner. IIRC, there were 3 or 4 options... you could use the "regular" base hospital system, you could enter into an agreement to exclusively use a single base hospital, or you could go entirely off-line. One of the companies I worked for chose the latter and we also had an agreement where we could also monitor K+ drips up to 20 mEq/L, which was also non-standard for the time. So... we basically never had to call-in for orders unless we actually reached the end of a protocol and there was nothing further if we were doing an IFT. If we were doing any kind of regular scene call, we had to use the regular base hospital system. Fortunately, like the regular 911 system, we rarely had to call in for orders...
