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Updates>
Revised Hospital Destination Guidelines
January 27, 2005
The Board of Directors today approved revisions to the
Region's Hospital Destination Guidelines. THIS REVISED
POLICY IS EFFECTIVE IMMEDIATELY. The revised
section of the CMTR Trauma Plan on "Selection of a Hospital
Destination is excerpted below.
To view a full text of the Trauma Plan, click on the
"Trauma Plan" tab on the left. The Plan is in PDF format,
and is bookmarked for quick navigation. Also, clicking on
the sections listed on the Contents page will link you
directly to the section desired.
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Selection of a hospital destination
General Guidelines:
The principal purpose of the trauma system is to ensure
that trauma patients receive prompt medical care at a level
which is appropriate to their medical needs. These
destination guidelines should not cause a substantial
increase or decrease from historical transfer patterns in
the volume of trauma patients treated at any given
hospital. Any significant increase or decrease in trauma
patient volume which cannot be explained by market
conditions could threaten system viability.
To be effective, the trauma system must ensure appropriate
allocation of patients among the facilities within the
region commensurate with the facilities’ cababilities and
the patients’ medical needs. Patients with severe or
complicated injuries are promptly transported to a Level I
or Level II Trauma Center, and those with injuries not
likely to require surgical or specialty care intervention
are routed to a Level III or Level IV facility, or
non-participating hospital. Selection of a hospital
destination must be a deliberate process.
Indecision results in over-triage, as minimally injured
patients are transferred to trauma centers, and
under-triage, as severely injured patients are taken to
facilities lacking adequate critical-care capabilities. In
general, priority is given to reduction of under-triage,
which may result in preventable mortality or morbidity from
delays in definitive care. However, reduction in
over-triage should also be an objective, to ensure that the
finite capacities of critical care facilities remain
available to receive patients requiring surgical or
specialty care.
As a general guideline, in cases where the need for
surgical or specialty care can be anticipated with
reasonable certainty, there should be no impediment to
transport (or transfer) to a Level I or Level II Trauma
Center. In less serious cases, where the necessity for
surgical or critical care is unlikely, the patient should
be routed to a Level III or Level IV facility, or
non-participating hospital.
To ensure the continued viability and effectiveness of the
trauma system, adherence to these destination policies will
be continuously reviewed by the Performance Improvement
Committee.
Specific Destination Guidelines:
Trauma patients with the following conditions should be
transported to the closest appropriate hospital:
· Cardiac Arrest
· Non-patent airway
· Hemodynamic compromise indicated by deteriorating vital
signs
Patient and or family request will be considered; however,
hospital selection is determined by the EMS Provider and
on-line Medical Control according to these guidelines and
is based entirely in the best medical interest of the
patient.
If the Paramedic/EMT has any doubt as to whether a patient
is a major trauma victim, he/she should consult with
Medical Control at the earliest stage possible in the
patient’s evaluation.
Patients should be transported directly to the nearest
hospital capable of managing their emergency condition. In
cases of severe trauma (RTS less than 11) this generally
means a Level I or Level II Trauma Center. In cases where
a patient is unstable and where a Level III/IV hospital is
much nearer than a Level 1/11 hospital, the patient may
benefit from initial stabilization at the Level III/IV
hospital.
For patients with a RTS of less than 11:
1. Level I or Level II Trauma Center Within Immediate Area:
Patients presenting with conditions which will obviously or
likely require surgical and/or critical care intervention,
such as those with an RTS <11, should be transported
directly to a Level I or Level II Trauma Center.
In cases where a patient presents with an RTS of 11 or
greater but for whom a thorough assessment by the paramedic
indicates that the patient has injuries likely to require
services available only at a Level I or Level II Trauma
center, the paramedic should contact online medical control
to request approval to bypass local hospitals.
Patients presenting with conditions not likely to require
surgical or critical care services should be transported to
the nearest Level III, Level IV or non-participating
hospital. This category includes patients with isolated
extremity trauma, head and/or facial trauma without
neurologic findings, and/or those with soft tissue
injuries. Patients who select a Level I or Level II Trauma
Center as their primary hospital destination should be
encouraged to make an alternate selection.
2. Level I or Level II Trauma Center Not in Immediate Area:
Transport all patients to the nearest appropriate facility.
If a thorough assessment by the paramedic indicates that
it would be in the patient’s best interest to bypass the
local hospital(s) and transport directly to a Level I or
Level II Trauma Center, he/she should contact Medical
Control for approval. In areas where radio/cellular
coverage prevents communication with Medical Control, the
paramedic may bypass the local hospital(s) only in those
cases where a local facility is without the capability to
manage the patient’s injuries, and transport to a Level I
or Level II would be of obvious benefit to the patient’s
care.
3. The use of an EMS helicopter for transport of critical
trauma patients may be beneficial. In cases where it is
appropriate to transport a patient to a community hospital,
the paramedic may request the launch of the UMC helicopter
prior to or during transport of the patient to the local
hospital.
[§I-4 rev. 1/27/05]
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