Interfacility/Transfers/Destination Decisions/Trauma

• <30 minutes:
• BMH
• KMC

>30 minutes-The closest hospital ED not on closure status.

• SECTION 1
• Posterior midline spinal pain or tenderness with a history of or suspicion of trauma.
• Numbness or weakness in any extremity after trauma.
• Injuries distracting patient from distinguishing spinal pain (e.g., pelvic fracture, multi-system trauma, crush injury to hands or feet, long bone fracture proximal to the knee/elbow, or to the humerus/femur.)
• Altered Mental Status GCS <15.
• Intoxication.
• Language Barrier, unless reliable translation is available.
• Age less than 3 or greater than 65.

• PAM-Co
• 1. Physiological
• 2. Anatomical
• 3. Mechanism of injury
• 4. Co-morbidity (age, preg, illness, etc.)

• (Vital Signs)
• GCS <14,
• BP <90,
• RR <10 or >29 ( <20 for infant less than 1 year)

• Penetrating injury to head, neck, torso, or extremity proximal to knee
• Flail chest
• Trauma with burns
• 2 or more proximal long bone fractures,
• Suspected pelvic fx
• Open or depressed skull fx
• Amputation proximal to wrist or ankle,
• Time sensitive extremity injury with vascular compromise

• Ejection, fall > 20’ adult or 2-3 x height of child
• Death in same compartment
• Extrication > 20 min
• High speed MVA
• Auto deformity > 20"”
• Pass. Compartment intrusion > 12” near pt. or
• 18” anywhere
• Auto vs. ped > 20 mph
• Pedestrian thrown or run over.

• Age >55
• Renal failure pt
• EMS personnel judgment
• OB pt. >20 weeks
• Bleeding disorder pt.

• Technically never, but a medic can elect to not do c-spine based on criteria. C-spine immobilization is based on criteria and NOT mechanism of injury. C-spine the following in the setting of significant trauma:
• Posterior midline spinal pain or tenderness with hx. of or suspected trauma.
• Hx. of blunt trauma and Step 1 or 2 trauma activation.
• Injury distracting from spinal pain (pelvic fx, multi-system trauma, crush inj. To hands or feet, long bone fx., )
• Severe head or facial trauma
• Numbness or weakness in any extremity after trauma
• LOC secondary to trauma
• If there’s ALOC and (w/ drugs, alcohol, and trauma)
• No hx available
• Found in setting of poss. Trauma
• Near drowning w/ poss. Diving inj.

A patient with an ALOC and in a setting of possible trauma (lying at the bottom of stairs, or in the street), a near drowning with poss. Diving injury, etc.

• Patient choice
• Closest, most appropriate hospital criteria.

KMC

• BMH
• KMC
• Mercy
• MSW
• AH-B

• BMH
• Heart
• AH-B

• BMH
• Heart
• AH-B

Patients that are fourteen (14) years and younger with an emergent medical complaint shall be transported to a Level I or Level II PedRC if ground transport time is thirty (30) minutes or less.

Ground transport times that are greater than thirty (30) minutes may be transported to the closest, most appropriate receiving hospital.

AH-B

ALL

KMC

Closest open hospital

• KMC
• DRMC
• KVH
• TH
• RRH

Closest open hospital

Conscious, alert, and oriented patients shall have a choice in destination, so long as the requested hospital is a Kern County EMS approved receiving center. (See above table) In the event that a conscious patient is adamant and insists on being transported to a hospital contrary to a case specific hospital which is most appropriate, the attendant shall attempt to obtain a signed AMA and continue appropriate care and transport to the requested hospital. At no time will an ambulance crew advise a patient that they have no choice in their destination hospital

Transportation coordinator at scene.

They should be cooled initially to stop burning process and then wrapped in dry, sterile dressing to prevent hypothermia***

Yes