Freestanding ED Transport Criteria

Section 1 - ADMINISTRATIVE POLICIES

1.21 FREESTANDING ED TRANSPORT CRITERIA

The following transport guidelines apply to any facility approved and designated as a free standing or stand alone emergency department as defined in Florida Statutes.

TRANSPORT INCLUSION CRITERIA

The following conditions are acceptable impressions that are suitable for transport to the freestanding emergency department:

Stable patients with medical or trauma complaints not likely to require emergent admission or acute surgical intervention. These include, but are not limited to:

• • Minor respiratory complaints
  • Fever, chills, flu-like symptoms
  • Cough, congestion, shortness of breath without signs of acute respiratory failure or unstable CHF
  • Isolated chest pain without other profound signs and symptoms, abnormal EKG, multiple or complicated pre-existing medical conditions.
  • Isolated musculoskeletal or orthopedic injuries
  • Isolated head trauma in adults without acute neurological deficits or high index of suspicion of a more complex problem
  • Headaches
  • General abdominal or flank pain without signs of acute abdomen or surgical emergency
  • Nausea/vomiting/diarrhea complaints without signs of shock
  • Traumatic injuries not likely to require urgent surgical intervention
  • Soft tissue injuries, lacerations, puncture wounds
  • Gynecological complaints, vaginal bleeding, pelvic pain without signs of shock or severe pain or symptoms consistent with acute abdomen
  • Urinary symptoms
  • Pediatric patients with general medical complaints without significant signs and symptoms of shock, cardiac symptoms, impending respiratory failure, altered mental status or have complicated pre-existing conditions likely to require admission to a pediatric facility.

Unstable patients

• • Cardiac arrest patients may be transported to the facility for stabilization
  • Unstable or unobtainable airway requiring immediate stabilization

• The transporting unit will remain in the free standing ED standing by for emergent transfer of the patient to the appropriate hospital in the event of a successful ROSC, airway is secured and patient is stabilized.

TRANSPORT EXCLUSION CRITERIA

The following conditions ARE NOT acceptable impressions for transport to the freestanding emergency department:

• All Emergent “Alerts”: STEMI, STROKE, SEPSIS, CARDIAC, TRAUMA
• Obstetrical patients
• Cardiac related complaints with significant signs and symptoms – CHF, dyspnea at rest, or patients with significant pre-existing medical conditions
• Patients exhibiting signs and symptoms consistent with an acute abdomen that most likely require urgent or emergent admission or surgical intervention
• Multi-system trauma
• Trauma Red patients
• Open fractures
• Pediatric patients with significant change in mental status or significant signs and symptoms that will most likely require admission to a pediatric facility including traumatic loss of consciousness
• Cardiac arrest patient who has had a positive Return of Spontaneous Circulation (ROSC) prior to arrival to the ED must be transported to the nearest appropriate ED with full hospital admission capabilities.

GENERAL TRANSPORT RULE TO FREESTANDING EDs:

Although it is impossible to list every complaint that meets criteria for transport to a freestanding emergency department, the general premise is to transport those patients who are NOT LIKELY to require emergent hospital admission, surgical or obstetrical intervention or other acute services not readily available in the freestanding ED. Pre-hospital providers are expected to closely evaluate the patient’s chief complaint, stability and condition to choose a transport destination that is IN THE BEST INTEREST OF THE PATIENT AND HIS OR HER CARE. When a situation arises where is questionable whether the patient meets freestanding ED transport criteria it is best to err in favor of transport to a full service initial facility.