64J-2.002. Prehospital Requirements for Trauma Care

(1) Each EMS provider shall ensure that upon arrival at the location of an incident, an EMT or paramedic shall assess the condition of each adult trauma patient using the adult trauma scorecard methodology to determine the transport destination, as provided in Rule 64J-2.004, F.A.C., and the transport destination of each pediatric patient by using the pediatric trauma scorecard methodology included in Rule 64J-2.005, F.A.C.

(2) Each EMS provider shall transport, or cause to be transported, every trauma alert patient to a trauma center nearest to the location of the incident, unless the distance is not relevant to the length of time for transport due to the use of an air ambulance. Pediatric trauma alert patients shall be transported to the nearest trauma center with pediatric services even if a trauma center without pediatric services is nearer to the location of the incident, except as provided in department-approved TTPs. If a trauma center further from the location of the incident has a special resource(s) that the nearest trauma center does not have, such as burn center or hyper baric chamber, which is needed for the immediate condition of the trauma alert patient, the EMS provider may transport to the trauma center having that special resource(s) even if the trauma center is not nearest to the incident. These exceptions to transporting to the nearest trauma center, or other exceptions the EMS provider wishes to request, shall be addressed in the EMS provider’s TTPs which shall be submitted to the department for approval, in accordance with Section 395.4045, F.S., and Rule 64J-2.003, F.A.C.

(3) A trauma alert patient may be transported to a hospital other than a trauma center only if the hospital is closer to the scene of the incident, and the patient’s immediate condition is such that the patient’s life will be endangered if care is delayed by proceeding directly to the trauma center. If an EMS provider intends to transport trauma alert patients to hospitals other than a trauma centers under any other circumstances, those circumstances must be described in and authorized by the EMS provider’s department-approved TTPs, as required in this section.

(a) An EMS provider must transport a trauma alert patient to a trauma center, except as may be provided in the EMS provider’s department-approved TTPs. For situations for which the EMS provider intends to transport a trauma alert patient to a hospital other than trauma center, as indicated in the provider’s or trauma agency’s department-approved TTPs, the EMS provider or trauma agency shall ensure beforehand that the hospital meets the following criteria:

1. Is staffed 24-hours-per-day with a physician and other personnel who are qualified in emergency airway management, ventilatory support, and control of life threatening circulatory problems which shall include but not be limited to placement of endotracheal tubes; establishment of central intravenous lines; and insertion of chest tubes;

2. Has equipment and staff in-hospital and available to conduct chest and cervical spine x-rays;

3. Has laboratory facilities, equipment and staff in-hospital and available to analyze and report laboratory results;

4. Has equipment and staff on call and available to initiate definitive care required by a trauma alert patient within 30 minutes of the patient’s arrival at the hospital, or can initiate procedures within 30 minutes of the patient’s arrival to transfer the trauma alert patient to a trauma center; and

5. Has a written transfer agreement with at least one trauma center. The transfer agreement shall provide specific procedures to ensure the timely transfer of the trauma alert patient to the trauma center.

(b) Any exceptions to this requirement shall be included in the EMS provider’s TTPs and be approved by the department.

(c) Prior to submitting an application for an ALS, BLS or air ambulance license, or to renew such a license, each EMS provider shall request in writing, from the chief executive officer of each hospital (excluding trauma centers) to which the EMS provider intends to transport trauma alert patient’s, written documentation that verifies that the hospital meets the requirements provided in paragraph (3)(a) of this section. When submitting TTPs for department approval, EMS providers shall include copies of each letter sent to the chief executive officer of such hospital as well as the response, if any, from the chief executive officer indicating whether the hospital complies with paragraph (3)(a) of this section.

(d) A trauma agency that has developed uniform TTPs may request written documentation from the hospitals in lieu of each EMS provider, in accordance with the requirements of this section.

(e) If an EMS provider does not receive a response from a hospital, or if the hospital indicates that it is not in compliance with the criteria in paragraph (3)(a) of this section, the EMS provider shall not deliver a trauma alert patient to that hospital. Any exception must also be included in the EMS provider’s department-approved TTPs.

(f) If a hospital’s compliance with the criteria in paragraph (3)(a) of this section changes during the EMS provider’s biennial licensure period, the EMS provider shall submit, within 30 days of becoming cognizant of the change, revised TTPs to the department for approval, in accordance with Rule 64J-2.003, F.A.C.

(g) If a hospital to which an EMS provider transports trauma alert patients, as provided in the EMS provider’s or trauma agency department-approved TTPs, becomes a trauma center, including those granted provisional status by the department, the EMS provider shall begin immediately transporting trauma alert patients to that trauma center. The EMS provider or trauma agency shall revise and submit TTPs to the department for approval within 30 days of the hospital becoming a trauma center. Within 30 days of an EMS provider or a trauma agency receiving notification that a trauma center intends to discontinue as a trauma center, the EMS provider or trauma agency shall submit revised TTPs to the department for approval, in accordance with Rule 64J-2.003, F.A.C.

(4) ALS non-transporting vehicle personnel shall provide to the transporting vehicle personnel complete information about the patient’s identity, the initial patient assessment and care provided prior to arrival of the transporting vehicle personnel, at the time that responsibility for the patient is transferred.

(5) The EMS provider responsible for the patient shall ensure that a prehospital trauma alert is issued upon determining that a trauma patient meets the requirements of Rules 64J-2.004 and 64J-2.005, F.A.C. The words “trauma alert” shall be used when notifying the trauma center, or hospital that EMS is en route with a trauma alert patient. The medical director of the EMS provider issuing the trauma alert, or the physician at the receiving trauma center, or hospital, are the only people authorized to change the trauma alert status. The EMS provider issuing the trauma alert shall also provide the trauma center or hospital with information required under subsection 64J-1.014(5), F.A.C., and the information listed below at the time the patient is transferred to the personnel of the receiving trauma center or hospital:

(a) Time of injury if different from the time of the call;

(b) Date of injury if different from day of call;

(c) County of injury;

(d) County of residence of patient;

(e) Cause of injury;

(f) Injury site/type;

(g) Trauma alert criteria if met as defined in Rule 64J-2.004 or 64J-2.005, F.A.C., and

(h) Protective devices if motor vehicle crash, bicycle or marine crash.

The information listed above shall be documented on the patient care record of the transporting unit that delivered the patient in accordance with the requirements of Rule 64J-1.014, F.A.C.

(6) Each EMS provider or trauma agency shall submit to the department TTPs for approval as required by the Trauma Transport Protocols Manual, December 2004, which is incorporated by reference and available from the department.

Specific Authority 395.4045, 395.405, 401.35 FS. Law Implemented 395.401-.403, 395.404-.405, 395.4045, 401.30, 401.35 FS. History–New 8-3-88, Amended 12-10-92, 11-30-93, Formerly 10D-66.100, Amended 8-4-98, 7-14-99, 2-20-00, 11-3-02, 11-24-02, 6-9-05, Formerly 64E-2.015.