1-2 HOSPITAL DESTINATION

General:

The patient should be transported to the area hospital with an emergency department of the patient’s choice.  In the event the patient is unconscious, the family’s wishes should be respected. If questioned about available institutions, all four available hospital emergency departments in Brown County should be offered. If the patient has no preference, they should be transported to the closest emergency department.

If there is a known incident or incidents involving multiple patients, when possible attempt to evenly distribute patients among appropriate receiving emergency departments.  Consider contacting receiving hospitals to determine their ability to receive and provide care for additional patients.

Patients desiring admittance to Brown County Mental Health Center or Bellin Psychiatric Hospital must first be medically cleared at an Emergency Department unless prior arrangements have been made (i.e. direct admit).

Major Trauma:

All patients meeting any of the following criteria should be transported to the closest appropriate trauma center (St. Vincent or Aurora BayCare). If the patient is competent and requests alternate destination, they should be informed of the potential risk of prolonging transport, and if they continue to request alternate destination, then contact medical control for direction. Contact medical control as soon as patient care safely allows, allowing for early activation of the trauma system.

·       Unresponsive to voice commands

·       Systolic blood pressure < 90 if over age 12, <70 if age 5-12 and <65 if under age 5

·       Respiratory rate less than 10 or greater than 30 breaths per minute

·       Inability to maintain an airway, including ineffective breathing, grunting or stridor in a child

·       Significant penetrating injury to the head, neck, torso or proximal extremity

·       Flail chest

·       Trauma with concurrent burns greater than 15% BSA

·       Distended, rigid abdomen with or without signs of shock

·       Two or more long bone fractures

·       Depressed or open skull fracture

·       Any pelvic fractures

·       New onset paralysis

·       Traumatic amputation proximal to wrist and ankle

·       Crushed, degloved or mangled extremity

Note: Pediatric patients under age 5 with major trauma should be transported to St. Vincent Hospital.

Possible Major Trauma

Consideration should be given to the transport of patients with the following criteria to the closest appropriate trauma center (St. Vincent or Aurora BayCare). If the patient is competent and requests alternate destination, they should be informed of the potential risk of prolonging transport, and if they continue to request alternate destination, then contact medical control for direction.

• Ejection from motor vehicle during crash
• Death of another occupant in the same motor vehicle in the crash
• Extrication time in excess of 20 minutes
• Falls from higher than 20 feet or 3 times the body length in children
• Victim of a roll over motor vehicle crash
• Victim of a high speed motor vehicle crash (>40 mph for adults, >20 mph for child)
• Major auto deformity, intrusion of damage into the passenger compartment
• Auto vs. pedestrian or bicycle
• Any motorcycle crash
• EMS Provider Judgment
• Trauma patient in extremes of age, less than 5 or over 55
• Injured patient with underlying
  • Severe lung disease
  • Significant cardiac disease
  • End stage renal disease requiring dialysis
  • Pregnancy > 20 weeks
  • Immunosuppression (transplant patients, oncology patients)
  • Known bleeding disorder or who is on anticoagulation medications

Pediatric patients under age 5 with major trauma should be transported to St. Vincent Hospital.

Dialysis Patients

Hemodialysis patients that are deemed stable and are being transported for the sole purpose of providing access to hemodialysis, should be preferentially transported to Aurora BayCare Medical Center, Bellin Hospital, or St. Vincent’s Hospital.

• St. Mary’s Hospital does not have dialysis capability readily available.
• If a patient is deemed unstable, they should be transported to the closest emergency department regardless of dialysis capability.
• If the stability of the patient is unclear, contact medical control as soon as possible for further direction.

Stroke Patients:

If a patient is identified as likely sustaining a stroke with a large vessel occlusion (LVO), and their symptoms have been present for less than 24 hours, they should be preferentially transported to Aurora BayCare Medical Center or St. Vincent’s Hospital.

• Aurora BayCare Medical Center and St. Vincent’s Hospital are capable of performing thrombectomy.  Bellin Hospital and St. Mary’s Hospital do not have this capability.
• The LA Motor Score (LAMS) should be used to identify stroke patients that may be sustaining an LVO.
  • LAMS scores of 4+ suggests that the patient may have an LVO.
• Patients with LAMS scores of <4 can be transported to the patient’s hospital of choice.
• If patient symptoms have definitely been present for > 24 hours, the patient can be transported to their hospital of choice.
• If a patient or their family insist on being transported to a non-thrombectomy ready facility, contact that facility as soon as possible for medical direction on how to best care for the patient.
• If a patient is deemed unstable, they should be transported to the closest emergency department regardless of thrombectomy capability.

Suspected stroke patients should be transported to Aurora BayCare Medical Center or St. Vincent’s Hospital if both conditions are met:

• LAMS score is 4+ AND
• Symptoms have been present for < 24 hours

Suspected stroke patients can be transported to their hospital of choice if either condition is met:

• LAMS score is <4 OR
• Symptoms have definitely been present for > 24 hours