(a) Assessment of the Trauma Patient. - (i) An initial assessment shall be performed to identify patients with major hemorrhage, hemodynamic instability, penetrating torso trauma, or signs of traumatic brain injury who may require immediate management of life-threatening injuries or rapid surgical intervention.
- (ii) After the initial assessment is complete and immediately identifiable life threatening injuries or conditions have been addressed, a secondary assessment to identify other injuries shall be performed unless a patient's condition and the requirement to continue treating an injury or condition prohibits the completion of an entire secondary assessment.
- (iii) Continuous monitoring for deterioration over time, including serial vital signs and repeated neurologic status assessment, shall be performed.
(b) Treatment of the Trauma Patient. - (i) All treatment provided to the trauma patient shall be done in conjunction with the preparation of the patient for rapid transport to a trauma facility.
- (ii) Hemorrhage control shall include appropriate dressing and bandaging and the early application of tourniquets in extremity trauma.
- (iii) Airway management shall be done with an appropriate level of cervical spine precautions.
- (iv) Spinal immobilization is not warranted in every trauma patient, and EMS protocols may be developed to allow discretion in determining which patients should receive this treatment.
- (v) The management of the patient may incorporate the concepts of permissive hypotension.
- (vi) EMS providers may withhold or terminate resuscitative efforts in the presence of:
- (C) Signs of rigor mortis or dependent lividity;
- (D) A mechanism of blunt trauma, and the patient is apneic, pulseless, and has no organized electrical activity on a cardiac monitor;
- (E) Cardiac arrest after a mechanism of trauma and who have no return to spontaneous circulation after 15-30 minutes of resuscitative efforts, including minimally interrupted cardiopulmonary resuscitation.
(c) Transport of the Trauma Patient. - (i) Patients who are assessed to have injuries consistent with Step One or Step Two as specified under Section 3(c)(i) of this chapter should be considered priority for transport to the facility with the highest level of capability.
- (ii) Any patient who does not qualify for immediate transport to a Trauma Center, but is determined to have injuries consistent with Step Three and Step Four as specified in Section 3(c)(i) of this chapter may be transported to the most appropriate facility in accordance with regional or local system guidelines.
- (iii) A transport may be refused, or an alternate destination requested, if the patient is determined to be of legal age, has the mental capacity to make an informed decision related to healthcare, and is not otherwise legally constrained from making such a decision. Under these circumstances, non-transport of the patient or transport of the patient to an alternate destination shall not violate this rule and shall not constitute refusal of care.
- (iv) When the required transport time is equal to or less than the required transport time to a facility with a lower level of capability, the ambulance shall transport to the higher level of capability as listed below in descending order of capability:
- (A) Trauma centers as defined in this chapter.
- (C) Community Trauma Hospital
- (D) Trauma Receiving Facility
- (v) The following exceptions apply to this subpart:
- (A) Ambulances will not transport chemical or radiation contaminated patients prior to decontamination;
- (B) If the Trauma Center chosen as the patient's destination is overloaded and cannot treat the patient, then the patient's destination shall be determined pursuant to regional or local system guidelines;
- (C) A transport may be diverted from the original destination if a patient's condition becomes unmanageable or exceeds the capabilities of the transporting ambulance.
- (vi) Situations giving rise to any exceptions listed in subpart (v) of this subsection should prompt review of that transport by the quality improvement process of the entire system.
048-15 Wyo. Code R. § 15-4