COUNTY OF SAN LUIS OBISPO HEALTH AGENCY PUBLIC HEALTH DEPARTMENT

Transcription

1 COUNTY OF SAN LUIS OBISPO HEALTH AGENCY PUBLIC HEALTH DEPARTMENT Michael Hill Health Agency Director Penny Borenstein, MD, MPH Health Officer/Public Health Director SLO County Emergency Medical Services Agency Bulletin PLEASE POST July 23 rd, 2018 Protocol Updates Effective August 1st, 2018 In coordination and response to the growth of our local Trauma System the EMS Agency has adopted two additional trauma triage criteria to Policy 153 in Step 2 (Anatomic) Criteria: Mangled, degloved or pulseless extremity Pelvic injury with high-risk mechanism of injury Addition of these criteria to Step 2 is consistent with the CDC s recommendations for prehospital trauma triage and direct transport to a trauma center. Both of these injury patterns are well known to benefit from the trauma team approach and rapid medical and surgical interventions available at a trauma center. In preparation for the August 1st release of the updates to Policy 153 please review the attached training packet created by Paramedic FTO Justin Bramlette. Your agencies Paramedic FTO s will be great resources to answer questions as they come up during review of the training materials. Please ensure you review these materials prior to the August 1st release date. In addition to Policy 153 updates, Paramedic Suzzane Sefcik has been assembling an excellent pediatric drug reference that aligns the Broselow tape or patient s weight to our local formulary and protocols. This resource will be very useful on critical pediatric calls, and should greatly reduce the risk for accidental dosing errors on these very high-stress calls. Look for its release soon. In coordination with the development of this pediatric drug reference, several minor clarifying changes were made to a few protocols. These administrative changes did not make any substantive medical changes; they simply clarified and unified the intent. The affected protocols are attached with the changes highlighted for your review. If you have any questions regarding these changes please do not hesitate to contact Douglas Brim, , dbrim@co.slo.ca.us. See attached Emergency Medical Services 2180 Johnson Avenue San Luis Obispo, CA (P) (F)

2 1 Criteria Adult Physiologic Glasgow Coma Scale 13 Systolic blood pressure <90 mmhg Respiratory rate <10 or > 29 breathe per minute Pediatric NO Physiologic Criteria NO Glasgow Coma Scale 13 Evidence of poor perfusion color, temperature, etc. Respiratory Rate o > 60/min or respiratory distress/apnea o < 20/min in infants < 1 yr Heart Rate o 5 yrs (<22 kg) < 80 or > 180/min o 6 yrs ( kg) < 60 or > 160/min Blood Pressure o Newborn (<1 month) SBP < 60mmHg o Infant (1mo to 1 yr) SBP <70 mmhg o Child (1yr to 10 yrs) SBP < 70mmHg + 2X age in yrs o Child (11 to 14 yrs) SBP < 90 mmhg NO Policy #153 - Attachment A Effective Date: 08/01/2018 Trauma Triage Decision Scheme Patients meeting one or more criteria activates TRAUMA ALERT Transport to closest TC Assess for anatomic injury 2 Anatomic Criteria All penetrating injuries to head, neck,torso, and extremities proximal to the elbow or knee Chest wall instability or deformity (i.e. flail chest) Two long bone fractures proximal to elbow or knee Mangled, degloved or pulseless extremity Open or depressed skull fracture Paralysis Pelvic injury with high-risk mechanism of injury NO TRAUMA ALERT Transport to closest TC Assess for mechanism 3 Mechanism of Injury Falls o Adults - > 20 feet (one story equals 10 feet) o Children - > 10 feet or two times their height High risk auto crash o Intrusion of passenger compartment space > 12 inches occupant site or > 18 inches any site including the roof/floor o Ejection (partial or complete) from automobile o Death in the same vehicle Auto vs pedestrian/bicycle thrown, run over, or with significant impact (> 20 mph) Motorcycle or unenclosed transport vehicle crash > 20 mph CONSULT TC for destination NO Assess for special considerations 4 Special Patient and System Considerations (*) EMS provider judgement Age > 65 yrs or < 14 yrs Anticoagulants therapy (excluding ASA) or other bleeding disorders with head injury (excluding minor injuries) Pregnancy > 20 weeks Burns with traumatic mechanism (*) Trauma Consult is not required for ground level/low impact falls with a GCS 14 (or GCS is normal for patient) follow SLO County Destination Policy # 151 NO Follow SLO County Destination Policy #151 CONSULT TC for destination Contact TC and transport to closest ED with Unmanageable airway Uncontrolled bleeding Traumatic arrest

3 County of San Luis Obispo Public Health Department Protocol #602 Division: Emergency Medical Services Agency Effective Date: 08/01/2018 AIRWAY MANAGEMENT ADULT PEDIATRIC (<34 kg) BLS Universal Protocol #601 Same as Adult (except for newborns) For foreign body/airway obstruction use current BLS choking procedures Newborn (< 1 day) follow AHA guidelines Newborn Protocol #651 Administer O 2 as clinical symptoms indicate (see notes below) BLS Optional Pulse oximetry Same as Adult Patients who have oxygen saturations 94% without signs or symptoms of hypoxia or impending respiratory compromise should not receive O 2 When applying O 2 use the simplest method to maintain O 2 Sat 94% Do not withhold O 2 if patient is in respiratory distress ALS Standing Orders If obstruction not relieved with BLS maneuvers If obstruction not relieved with BLS maneuvers o Visualize and remove obstruction with o Visualize and remove obstruction with Magill forceps Magill forceps o If obstruction persists consider Needle o If obstruction persists consider Needle Cricothyrotomy Procedure #704 Cricothyrotomy Procedure #704 o Upon securing airway monitor O 2 Sat and o Upon securing airway monitor O 2 Sat and ETCO 2 Capnography Procedure #701 CPAP as needed for moderate to severe distress CPAP procedure #703 Endotracheal intubation as needed to control airway Needle thoracostomy with symptoms of tension pneumothorax Needle Thoracostomy Procedure #705 ETCO 2 Capnography Procedure #701 Needle thoracostomy with symptoms of tension pneumothorax Needle Thoracostomy Procedure #705 Base Hospital Orders Only Symptomatic Esophageal Obstruction Symptomatic Esophageal Obstruction o Glucagon 1mg IV followed by rapid flush. o Glucagon 0.1mg/kg IV not to exceed Give oral fluid challenge 60 sec after 1mg followed by rapid flush. Give oral admin - check a blood sugar prior fluid challenge 60 sec after admin - As needed check a blood sugar prior As needed Notes Oxygen Delivery o Mild distress L/min nasal cannula o Severe respiratory distress 15 L/min via non-rebreather mask o Moderate to severe distress CPAP 3-15 cm H2O o Assisted respirations with BVM 15 L/min Pediatric intubation is no longer an approved ALS skill maintain with BLS options

4 County of San Luis Obispo Public Health Department Protocol #614 Division: Emergency Medical Services Agency Effective Date: 08/01/2018 INGESTION/POISONING/OD ADULT PEDIATRIC ( 34KG) BLS Universal Protocol #601 Same as Adult Decontaminate at scene Dry substance o Remove contaminated clothing o Brush off substance prior to flushing with large quantities of water Liquid substance o Remove contaminated clothing o Flush with large quantities of water Eye involvement o Flush with normal saline when available for minimum of 15 min BLS Optional Pulse Oximetry O 2 administration per Airway Management Protocol #602 ALS Standing Orders If alert with normal gag reflex, ingestion within 1 hour and no contraindications If alert with normal gag reflex, ingestion within 1 hour and no contraindications o Activated Charcoal 50 Gm PO o Activated Charcoal 25 Gm PO Base Hospital Orders Only Beta Blocker Overdose Beta Blocker Overdose o Glucagon 3-10 mg slow IV/IO (when o Glucagon 0.1 mg/kg IV/IO/IM cache available) Calcium Channel Blocker Overdose Calcium Channel Blocker Overdose o Calcium Chloride 20mg/kg slow IV/IO o Calcium Chloride 1 Gm slow IV/IO not to exceed 500 mg per dose Organophosphate Overdose Organophosphate Overdose o Atropine 2 mg IV/IO/IM repeat as o Atropine mg/kg IV/IO/IM needed Tricyclic Overdose with tachycardia and Tricyclic Overdose with tachycardia and signs of QRS widening signs of QRS widening (> 0.1 seconds) o Sodium Bicarbonate 1mEq/kg IV/IO, o Sodium Bicarbonate 1 meq/kg IV/IO, may repeat every 10 minutes at ½ the may repeat every 10 minutes at ½ the initial dose with persistent wide QRS. initial dose with persistent wide QRS. As needed As needed Notes If suspected opiate overdose AND inadequate respirations with a O 2 sat < 94% or ETCO 2 > 45 mmhg see Respiratory Depression Opiate Overdose Protocol #618 for Narcan administration Activated Charcoal contraindicated for: o Ingestion of caustics or corrosives o Ingestion of cyanide, heavy metal, petroleum distillates o ALOC or lack of gag reflex Consider nerve agents, carbon monoxide or organophosphate exposure with multiple victims see Hazmat Training Standards Policy #201 Protect rescuers from exposure due to contact with substance or secondary exposure through patient contact

5 County of San Luis Obispo Public Health Department Protocol #641 Division: Emergency Medical Services Agency Effective Date: 08/01/2018 Replaces BLS # 501 Medical Cardiac Arrest and ALS# 610 Adult Pulseless Arrest PULSELESS CARDIAC ARREST (ATRAUMATIC) ADULT BLS Universal Protocol #601 High Performance CPR (HPCPR) (10:1) per Procedure #712 o Continuous compressions with 1 short breath every 10 AED application (if shock advised, administer 30 compressions prior to shocking) PEDIATRIC ( 34 kg) Same as Adult (except for neonate) Neonate (< 1 month) follow AHA guidelines CPR compression to ventilation ratio o Newborn CPR 3:1 o 1 day to 1 month CPR 15:2 o > 1 month HPCPR 10:1 AED pediatric patient > 1 year Use Broselow tape or equivalent if available BLS Optional Pulse Oximetry O 2 administered per Airway Management Protocol #602 ALS Standing Orders Rhythm analysis and shocks At 200 compressions begin charging the monitor continue CPR while monitor is charging. Once fully charged, stop CPR for rhythm analysis: o V-fib/Pulseless V-tach shock at 120J o Subsequent shock at 150J then 200J o Recurrent V-fib/Pulseless V-tach use last successful shock level o No shock indicated dump the charge V-fib/Pulseless V-tach medications o Epinephrine 1:10,000 1 mg IV/IO repeat every 3-5 min o Lidocaine 1.5 mg/kg IV/IO repeat once in 3-5 min (max total dose 3 mg/kg) Non-shockable rhythm medications o Epinephrine 1:10,000 1 mg IV/IO repeat every 3-5 min Base Hospital Orders Only Contact STEMI Receiving Center (French Hospital) Dopamine 5-20 mcg/kg/min if BP < 100 mmhg V-Fib or V-Tach refractory to treatment Request for a change in destination if patient rearrests en route Termination orders when unresponsive to resuscitative measures As needed Contact appropriate Base Station per Base Station Report Policy #121 - Atraumatic cardiac arrests due to non-cardiac origin (OD, drowning, etc.) Rhythm analysis and shocks At 200 compressions begin charging the monitor continue CPR while monitor is charging. Once fully charged, stop CPR for rhythm analysis: o V-fib/Pulseless V-tach - shock at 2J/kg o Subsequent shock at 4J/kg o Recurrent V-fib/Pulseless V-tach use last successful shock level o No shock indicated dump the charge V-fib/Pulseless V-tach medications o Epinephrine 1:10, mg/kg (0.1 ml/kg) IV/IO, not to exceed 0.3mg, repeat every 3-5 min o Lidocaine 1 mg/kg IV/IO repeat every 5 min (max total dose 3 mg/kg) Non-shockable rhythm medications o Epinephrine 1:10, mg/kg (0.1 ml/kg) IV/IO, not to exceed 0.3mg, repeat every 3-5 min As needed Contact closest Base Hospital for additional orders

6 County of San Luis Obispo Public Health Department Protocol #641 Division: Emergency Medical Services Agency Effective Date: 08/01/2018 Replaces BLS # 501 Medical Cardiac Arrest and ALS# 610 Adult Pulseless Arrest Notes Use manufacturer recommended energy settings if different from listed Assess for reversible causes o Tension PTX, hypoxia, hypovolemia, hypothermia, hyperkalemia, hypoglycemia, overdose Vascular access IV preferred over IO continue vascular access attempts even if IO access established Oral Intubation (Adults) Consider only if airway is not compliant or with maintained ROSC Adult ROSC that is maintained: o Obtain 12-lead ECG and vital signs o Transport to the nearest STEMI Receiving Center regardless of 12-lead ECG reading o Maintain O 2 Sat > 94% o Monitor ETCO 2 o Consider oral intubation o With BP < 100 mmhg, contact SRC (French Hospital) for fluid or Dopamine orders Termination for patients > 34 Kg - Contact SRC (French Hospital) for termination orders o If the patient remains pulseless and apneic following 20 minutes of resuscitative measures o Persistent ETCO 2 values < 10mmHg, consider termination of resuscitation o Documentation shall include the patient s failure to respond to treatment and of a nonviable cardiac rhythm (copy of rhythm strip) Pediatric patients 34 kg o Stay on scene to establish vascular access, provide for airway management, and administer the first dose of epinephrine followed by 2 min of HPCPR. o Emphasize quality CPR rather than immediate transport o Evaluate and treat for respiratory causes o Use Broselow tape if available o Contact and transport to the nearest Base Hospital o Receiving Hospital shall provide medical direction/termination for pediatric patients

7 County of San Luis Obispo Public Health Department Protocol #644 Division: Emergency Medical Services Agency Effective Date: 08/01/2018 BRADYCARDIA ADULT PEDIATRIC ( 34KG) BLS Universal Protocol #601 Same as Adult BLS Optional Pulse Oximetry O 2 administration per Airway Management Protocol #602 ALS Standing Orders Obtain 12-lead ECG Obtain 12-lead ECG With STEMI contact STEMI base prior to administration of Atropine unless in extremis Unstable Unstable Epinephrine 1:10, mg/kg (0.1 ml/kg) slow IV/IO not to exceed 0.3 mg per dose Atropine 0.5 mg IV/IO o May repeat every 3-5 min o May repeat every 3-5 min (not to exceed 3 mg total) Base Hospital Orders Only Normal Saline fluid bolus 500 ml Atropine 0.02 mg/kg IV (minimum dose of 0.1 Atropine 0.5 mg IV for stable patient or STEMI mg and maximum dose of 0.5 mg) patient not in extremis o May repeat every 3-5 min (not to Dopamine 5-20 mcg/kg/min exceed 1 mg total) Beta Blocker Overdose Normal Saline fluid bolus 20 ml/kg o Glucagon 3-10 mg slow IV/IO (when Beta Blocker Overdose cache available) o Glucagon 0.1 mg/kg IV/IO/IM Calcium Channel Blocker Overdose Calcium Channel Blocker Overdose o Calcium Chloride 1 Gm slow IV/IO o Calcium Chloride 20mg/kg slow IV/IO Organophosphate Overdose not to exceed 500 mg per dose o Atropine 2 mg IV/IO/IM repeat as Organophosphate Overdose needed o Atropine mg/kg IV/IO/IM Tricyclic Overdose with signs of QRS Tricyclic Overdose with signs of QRS widening (>0.1 seconds) widening o Sodium Bicarbonate 1 meq/kg IV/IO, o Sodium Bicarbonate 1 meq/kg IV/IO, may repeat every 10 minutes at ½ the may repeat every 10 minutes at ½ the initial dose with persistent wide QRS. initial dose with persistent wide QRS. Hyperkalemia As needed o Calcium Chloride 1 Gm slow IV/IO o Sodium Bicarbonate 1 meq/kg IV/IO As needed Notes Atropine in pediatric patients may cause paradoxical bradycardia High degree heart blocks (Second degree type II, and Third degree) may respond poorly to Atropine o If unstable consider obtaining Base Hospital Orders for Dopamine instead of Atropine Ensure all Calcium Chloride is thoroughly flushed from IV tubing prior to administration of Sodium Bicarbonate Higher doses of Atropine may be needed for organophosphate OD

8 County of San Luis Obispo Public Health Department Calcium Chloride Division: Emergency Medical Services Agency Effective Date: 04/15/2017 Classification: Electrolyte CALCIUM CHLORIDE (CaCl2) (Base Hospital Order Only) Actions: Indications: Contraindications: 1. Acts as an activator in transmission of nerve impulses and contraction of cardiac, skeletal, and smooth muscles. 2. Maintains cell membrane and capillary permeability. 1. Cardiac arrest or significant instability associated with hyperkalemia (suspect in renal failure) or Ca channel blocker toxicity. 2. Overdose on Calcium Channel Blocker medications. Hypercalcemia Adverse Effects: Administration: Cardiovascular Cardiac arrest ADULT DOSE 1 Gm slow IVP/IO Metabolic Hypercalcemia PEDIATRIC DOSE 20 mg/kg slow IVP/IO not to exceed 500 mg per dose Onset: Duration: Immediate 30 minutes - 2 hours Notes: Calcium Chloride will precipitate if in a solution with Sodium Bicarbonate.

9 County of San Luis Obispo Public Health Department Epinephrine 1:10,000 (Adrenalin ) Division: Emergency Medical Services Agency Effective Date: 08/01/2018 EPINEPHRINE 1:10,000 (Adrenalin ) Classification: Sympathomimetic agent (catecholamine) Actions: Indications: Contraindications: 1. Increases cardiac output due to increased inotropy, chronotropy, dromotropy, and AV conduction (b1 effect) 2. Relaxes smooth muscles of the respiratory tract (b2 effect) 3. Increases systolic blood pressure due to increased cardiac output (b1effect) and vasoconstriction (a effect) 4. Increases coronary perfusion during CPR by increasing aortic diastolic pressure 1. Cardiopulmonary arrest 2. Anaphylaxis 3. Respiratory distress with wheezing 4. Pediatric symptomatic bradycardia 5. Neonatal resuscitation 6. Suspected croup or epiglottitis 1. Use with caution in pregnancy. 2. Consider base physician consultation if possible if the patient has a history of MI, angina or hypertension. Adverse Effects: Cardiovascular Neurological Tachycardia Anxiety Hypertension Dizziness Chest pain Headache Palpitations Tremors Ventricular fibrillation Seizures Gastrointestinal Nausea/vomiting Administration: ADULT DOSE 1. Cardiac Arrest: 1 mg IVP/IO, may repeat every 3-5 minutes 2. Anaphylaxis: base physician order only 0.01 mg/kg, slow IVP titrated, not to exceed 0.5 mg 3. Asthma: base physician order only 0.01 mg/kg, slow IVP titrated, not to exceed 0.5 mg PEDIATRIC DOSE 1. Cardiac Arrest: 0.01 mg/kg (0.1 ml/kg) slow IVP/IO, not to exceed 0.3 mg per dose, repeat every 3-5 minutes

10 EPINEPHRINE 1:10,000 (Adrenalin ) Page 2 of 2 EPINEPHRINE 1:10,000 (Adrenalin ) - continued Notes: 2. Symptomatic Bradycardia: 0.01 mg/kg (0.1 ml/kg) slow IVP/IO, not to exceed 0.3 mg per dose, repeat every 3-5 minutes 3. Anaphylaxis: base physician order only 0.01 mg/kg (0.1 ml/kg) slow IVP titrated, not to exceed 0.3 mg 4. Respiratory Distress: base physician order only 0.01 mg/kg (0.1 ml/kg) slow IVP titrated, not to exceed 0.3 mg Use Epinephrine with caution in older patients. If a patient is clearly in anaphylaxis, this is the drug of choice, even in older patients. If doubt exists, initiate early base hospital contact, prior to drug therapy. Tachycardia is not a contraindication to Epinephrine. Base physician order for Epinephrine 1:10,000, 0.01mg/kg titrated IV not to exceed 0.5mg for circulatory collapse from anaphylaxis. IM administration is with 1-1½" needle in anterior/lateral thigh or deltoid.

11 County of San Luis Obispo Public Health Department Page 1 of 5 Division: Emergency Medical Services Agency Effective Date: 08/01/2018 POLICY #153: TRAUMA PATIENT TRIAGE AND DESTINATION I. PURPOSE A. To establish guidelines for EMS personnel to identify and transport significantly injured patients who could benefit from the rapid response and specialized services of a trauma center. II. SCOPE A. This policy applies to both adult and pediatric injured patients, unless stated otherwise. III. PROCEDURE A. Trauma Activation Criteria 1. STEP 1 or STEP 2 TRAUMA ALERT - Patient meeting any one of the Physiologic (Step 1) and/or Anatomic criteria (Step 2) following a traumatic event shall be designated a TRAUMA ALERT and transported to the closest trauma center. 2. STEP 3 TRAUMA CONSULTATION - Patient meeting (Step 3) Mechanism of Injury - contact with the County of San Luis Obispo (SLO) Trauma Center for patient destination. 3. STEP 4 TRAUMA CONSULTATION - shall be made with the SLO Trauma Center to determine destination when the paramedic identifies a significantly injured patient that DOES NOT meet the Step 1 (Physiologic), Step 2 (Anatomic) or Step 3 (Mechanism of Injury) criteria but meets one or more of the special patient or system considerations B. Trauma Patient Criteria Patients meeting any one of the Physiologic and/or Anatomic criteria following a traumatic event shall be a TRAUMA ALERT and transported to the closest trauma center. Patient meeting Mechanism of Injury and/or Special Patient/System Considerations shall be a TRUAMA CONSULT and contact the County of San Luis Obispo (SLO) Trauma Center for patient destination. 1. STEP 1 (Physiologic Criteria) a. Adult injured patients meeting any one of the following criteria: 1. Glasgow Coma Scale 13 (based on patient history and attributed to injury) 2. Systolic blood pressure <90 mmhg 3. Respiratory rate <10 or >29 breaths per minute b. Pediatric injured patients ( 34 Kg) meeting any one of the following criteria:

12 POLICY #153: TRAUMA PATIENT TRIAGE AND DESTINATION Page 2 of 5 1. Glasgow Coma Scale 13 (based on patient history and attributed to injury) 2. Evidence of poor perfusion color, temperature, etc. 3. Respiratory rate 4. Heart rate >60 breaths per minute or respiratory distress <20 breaths per minute in infants <1year 5 years (<22Kg) heart rate <80 beats per minute or >180 beats per minute 6 years (23-34Kg) heart rate <60 beats per minute or >160 beats per minute 5. Blood pressure Newborn (<1 month) systolic blood pressure <60mmHg Infant (1 month -1 year) systolic blood pressure <70mmHg Child (1 year-10 years) systolic blood pressure <70mmHg + 2X age in years Child (11-14 years) systolic blood pressure <90mmHg 2. STEP 2 (Anatomic Criteria) Injured patients meeting any one of the following criteria: a. All significant penetrating injuries to head, neck, torso and extremities proximal to knee or elbow b. Chest wall instability or deformity (e.g. flail chest) c. Two proximal long bone fractures (above the elbows and or knees) d. Mangled, degloved or pulseless extremity e. Open or depressed skull fracture f. Paralysis g. Pelvic injury with high-risk mechanism of injury (motor vehicle collisions, auto vs. pedestrian accidents, motorcycle collisions, falls from heights) 3. STEP 3 (Mechanism of Injury Criteria) Injured patients meeting any one of the following criteria: a. Falls 1. Adults: >20 feet (one story is equal to 10 feet) 2. Pediatric ( 34kg) : >10 feet or two times the height of the child b. High-risk auto crash:

13 POLICY #153: TRAUMA PATIENT TRIAGE AND DESTINATION Page 3 of 5 1. Passenger Space Intrusion (PSI) of space: >12 inches occupant patient site; or >18 inches anywhere within the passenger space 2. Ejection (partial or complete) from automobile 3. Death in same passenger compartment c. Auto vs. pedestrian/bicyclist thrown, run over, or with significant impact (>20 mph) d. Motorcycle or unenclosed transport vehicle crash (>20 mph) 4. STEP 4 (Special Patient or System Considerations) Age and co-morbid considerations. a. EMS provider judgment b. Age greater than SBP <110 mmhg may represent shock c. Pediatric ( 34kg) d. Pregnancy > 20 weeks e. Anticoagulation therapy (excluding aspirin) or other bleeding disorders with head injury (excluding minor injuries) Note: f. Burns with trauma mechanism A TRAUMA CONSULT is not required for ground level/low impact falls with GCS 14 or when the GCS is normal for patient C. Contact the Trauma Center Contact the receiving trauma center early and immediately upon determining the patient meets trauma patient triage criteria with a TRAUMA ALERT or TRAUMA CONSULTATION 1. TRAUMA ALERT A TRAUMA ALERT is initiated when an injured patient meets any one of the Step 1 (Physiologic) or Step 2 (Anatomic) Criteria. Consider early notification to the intended receiving Trauma Center, from the scene when possible a. EMS personnel should provide a TRAUMA ALERT early and from the scene when possible to assist in early activation of the trauma team and determination of patient destination. b. ALS personnel must contact the trauma center with the TRAUMA ALERT. c. A TRAUMA ALERT report should include the following: 1. TRAUMA ALERT meeting trauma triage step criteria x 2. Unit and medic #

14 POLICY #153: TRAUMA PATIENT TRIAGE AND DESTINATION Page 4 of 5 3. ETA to trauma center 4. Report on individual patient (MIVT format): Age and sex Mechanism of injury Injury and complaints Vital signs including GCS Treatment Include specific triage findings or considerations that identify the patient as meeting TRAUMA ALERT criteria. 2. TRAUMA CONSULTATION TRAUMA CONSULTATION with a SLO trauma center should be obtained to determine trauma patient destination when Step 3 (mechanism(s) of injury) criteria or Step 4 (special considerations) are present and Step 1 (physiologic) and Step 2 (anatomic) criteria are NOT met. a. Only ALS personnel may request a TRAUMA CONSULTATION for patient destination b. A TRAUMA CONSULTATION report should include the following: 1. TRAUMA CONSULTATION meeting trauma triage step criteria x 2. Unit and medic # 3. ETA to trauma center and ETA to closest ED (When the trauma center is the closest facility include in the radio contact information notifying them they are the closest receiving facility) 4. Report on the individual patient: (MIVT format) c. Paramedic Concerns Patient age and sex Mechanism of injury and scene Injury and complaints Vital signs including GCS Treatment and response Include specific findings or considerations that identify the patient as meeting TRAUMA CONSULTATION criteria 3. The Trauma center, when not receiving the patient, shall notify the receiving hospital of the incoming patient and provide that hospital with the prehospital care patient information. 4. When practical, a brief updated report should be given to the trauma center Hospital and include any significant changes in route in vital signs, GCS, physical findings, symptoms or treatments.

15 POLICY #153: TRAUMA PATIENT TRIAGE AND DESTINATION Page 5 of 5 D. Exceptions to Direct Transport to a Trauma Center Trauma patients will be transported to the closest ED in the following situations: 1. Patient condition necessitates transport to the closest ED, such as the following: a. Unmanageable airway (intubation attempts are unsuccessful and an adequate airway cannot be maintained with BVM or other device) b. Uncontrollable bleeding with rapidly deteriorating vital signs c. Traumatic cardiac arrest see EMS Agency Prehospital Determination of Death/Do Not Resuscitate (DNR) End of Life Care Policy # SLO Trauma Center destination order 3. Patient refusal - see EMS Agency Patient Refusal of Treatment and/or Transport Policy # Trauma center is on complete diversion see EMS Agency Hospital Diversion Policy #154: Hospital Diversion. E. The utilization of EMS helicopter for the response and transport of trauma patients must be in accordance with EMS Agency EMS Helicopter Operations. EMS Helicopter Policy #155 transport should be considered when ground transport is greater than 30 minutes from the trauma center and air transport would be more expeditious than ground transport. IV. V. AUTHORITY California Health and Safety Code, Division 2.5. California Code of Regulations, Title 22, Chapter 7 ATTACHMENTS A. Trauma Triage Matrix