16 Del. Admin. Code § 4305-7.0

Current through Register Vol. 28, No. 7, January 1, 2025

Section 4305-7.0 - State of Delaware Triage, Transport, and Transfer Protocols

7.1 Due to the dynamic nature of identification and evolution of best practices in prehospital care, the prehospital trauma triage guidance shall be found solely in the current State of Delaware, Department of Health and Social Services, Division of Public Health, Office of Emergency Medical Services, Statewide Standard Treatment Protocols, Guidelines, Policies, and Paramedic Standing Orders and Statewide Standard Treatment Protocols and Basic Life Support Standing Orders. The Trauma System Committee shall be asked for input by the State EMS Medical Director through the Trauma System Manager during every Standing Orders revision process.

7.2 If transport time between 2 trauma centers is relatively equal, critically injured trauma patients should be transported directly to the higher-level trauma center. Patients with significant head trauma as evidenced by a Glasgow Coma Score of 8 or less, or spinal cord trauma as evidenced by new onset limb paralysis or weakness should be transported directly to a Level I or Level II Trauma Center with an available neurosurgeon when possible. Availability of air transport will impact these time and distance decisions and may potentially save the patient the time required for later interfacility transfer as well as keep the helicopter available for scene medevac work.

7.3 In order to be considered a participant in Delaware's Trauma System, an out-of-state facility must receive Delaware reciprocity as a trauma center by demonstrating current trauma center designation status and adherence to equivalent trauma standards.

7.4 Air Transport Guidelines

7.4.1 Utilization of aeromedical services has become a nationally accepted standard for the rapid evacuation and transportation of critically injured patients to the most appropriate medical facility for definitive medical care. In order to make the best decisions about the most appropriate mode of transport for a particular patient, multiple factors must be considered. Clinical factors relate to the patient and are described in the Delaware Paramedic and Basic Life Support Standing Orders. Operational factors relate to the transport process and include helicopter availability and location measured against ground transport time. Weather, traffic, ground unit availability, and scene accessibility are other operational factors which must be considered on a case-by-case basis.

7.4.2 Air transportation from the scene is appropriate for a seriously injured trauma patient. These decisions shall be based on current State of Delaware, Department of Health and Social Services, Division of Public Health, Office of Emergency Medical Services, Statewide Standard Treatment Protocols, Guidelines, Policies, and Paramedic Standing Orders and Statewide Standard Treatment Protocols and Basic Life Support Standing Orders.

7.4.3 To avoid excessive time spent on scene awaiting arrival of the aircraft, the helicopter should be dispatched at the time of initial ALS dispatch or immediately upon arrival of the first units on scene. It is in the patient's best interest for the aircraft to be dispatched early rather than to wait for ground unit request when available information suggests a major incident. When appropriate, consideration may be given to rendezvous.

7.5 Interfacility Transfer Decisions

7.5.1 The most appropriate mode of transportation to be utilized when an interfacility transfer is being arranged is a decision made by the referring physician. Operational factors as well as clinical factors must be considered in arriving at the best transport decision in each circumstance.

7.5.2 High-risk Criteria for Consideration of Early Transfer of Injured Patients: See Appendix C, Delaware System Trauma Plan, July 2023 Version, and any subsequent revisions.

7.5.3 Interfacility Transfer Protocol: See Appendix C Delaware System Trauma Plan, July 2023 Version, and any subsequent revisions.

7.5.4 Interfacility transfer decisions must follow the Acceptance of Critically Injured Patients for Acute Tertiary Care, September 2019, See Appendix C, Delaware System Trauma Plan, July 2023 Version and any subsequent revisions.

7.5.5 Burn Center Referral Criteria: See Appendix C, Delaware System Trauma Plan, July 2023 Version and any subsequent revisions.

16 Del. Admin. Code § 4305-7.0

27 DE Reg. 529( 1/1/2024) (Final)