Current through Register Vol. 35, No. 6, March 26, 2024
A.
Each pre-hospital EMS provider
shall: ensure, upon arrival at the location of an injury, a trained
first responder or EMT assessment of the condition of each trauma patient using
the local/regional trauma triage criteria to determine the transport
destination according to local trauma transport protocols (TTPs).
B.
The local TTPs will take into
consideration the following exceptions:
(1) EMS Air Ambulance; when transporting by
ground is not appropriate due to distance, terrain, traffic or other reasons,
activation of an EMS air ambulance should be considered as provided for in the
local TTPs. Consideration for EMS air ambulance activation shall include:
(a) multiple trauma patients,
(b) disaster situations,
(c) poorly accessible terrain,
(d) excessive or impeding traffic,
(e) transport time greater than thirty (30)
minutes, or,
(f) potential to
overload the closest hospital or EMS service.
(2) pediatric trauma: pediatric trauma
patients shall be transported to the nearest designated trauma center that
meets essential pediatric guidelines pursuant to these regulations, as provided
for in the local TTPs.
(3) special
needs: if a designated trauma center is farther from the location of the
incident, has special resources that the nearest designated trauma care
hospital does not have (such as burn capability), which is needed for the
immediate condition of the trauma patient, the pre-hospital EMS provider may
transport to the designated trauma center having the needed resource based on a
specific approved local TTP. Special needs may include:
(a) burns,
(b) re-implantation,
(c) pregnancy,
(d) spinal cords/head injuries,
(e) hazardous material exposure,
or,
(f) age less than two (2) years
or greater than sixty (60) years and,
(g) other medical conditions requiring
specialized services that may be included in the local TTP specific and
appropriate to the patient's needs.
(4) other circumstances: if a designated
trauma center is greater than thirty (30) minutes away by ground transport, a
trauma patient may be transported to a hospital other than a trauma center only
if the hospital is closer to the incident and the patient's immediate condition
is such that the patient's life would be endangered if care was delayed by
proceeding directly to the nearest trauma center. Transport of patients shall
be based on approved local TTPs.
C.
Pre-hospital EMS providers
shall: have an approved TTP that requests alternative transport
destinations as provided for in this paragraph. The local TTP shall specify
specific exceptions and define the Process improvement (PI) plan to monitor
protocols.
D.
Where a
pre-hospital EMS provider intends to transport a trauma patient to a facility,
as provided for in the approved local TTPs: the pre-hospital EMS service
and the medical director in collaboration with the Bureau shall ensure that the
hospital meets all of the following:
(1) is
staffed twenty-four (24) hours per day with a physician or at least a mid-level
practitioner who is qualified in emergency airway management, ventilatory
support, and control of life threatening circulatory problems which shall
include, but not be limited to:
(a) placement
of endotracheal tubes,
(b)
establishment of intravenous access, and
(c) insertion of chest tubes.
(2) has equipment and staff to
conduct chest and cervical/spinal radiological exams.
(3) has laboratory facilities, equipment and
staff available to analyze and report patients blood and chemistry
results;
(4) has equipment and
staff promptly on call to initiate definitive care required by a trauma patient
within thirty (30) minutes of the patient's arrival at the hospital, or can
initiate procedures within thirty (30) minutes of the patient's arrival to
transfer the trauma patient; and
(5) has written transfer agreements with a
designated trauma center which identifies specific procedures to ensure the
timely transfer of the trauma patient to the designated trauma care
hospital.
E.
A
hospital/healthcare facility licensed in another state: which meets the
above criteria may be identified in the local TTPs as a hospital/healthcare
facility to which the EMS provider may transport a trauma patient.
F.
These transport guidelines are
considered in conjunction with all applicable laws and regulations. The
Bureau may request copies of the local TTPs
