(b) The following patients, when identified, shall be given consideration for early transfer to a facility with specific expertise in their care:

1. (1) Comorbidities. A trauma patient presenting with any one (1) of the following comorbidities shall be considered a candidate for rapid transfer:

   1. (A) Age less than ten (<10) years or greater than or equal to fifty-five (≥55) years;
   2. (B) Patients taking anticoagulation with any head or brain injury; or
   3. (C) Pregnancy when obstetrics monitoring is unavailable;

2. (2) Burn patients. A trauma patient presenting with any one (1) of the following criteria shall be considered a candidate for rapid transfer to a specialized burn center (all centers transferring burn patients shall utilize telemedicine when requested by the burn center):

   1. (A) Second and third degree burns greater than ten percent (>10%) body surface area in patients less than ten (<10) years or more than fifty (>50) years;
   2. (B) Second and third degree burns greater than twenty percent (>20%) body surface area in other age groups;
   3. (C) Second and third degree burns involving face, hands, feet, genitalia, or perineum, or which involve skin overlying major joints;
   4. (D) Third degree burns greater than five percent (>5%) body surface area;
   5. (E) High voltage electrical burns, including lightning injury;
   6. (F) Significant chemical burns;
   7. (G) Inhalation injury;
   8. (H) Burn injury in patients with preexisting conditions that could complicate management, prolong recovery, or affect mortality;
   9. (I) Any burn patient in whom concomitant trauma poses an increased risk of morbidity or mortality may be initially treated in a trauma center until stable before appropriate transfer to a burn center;
   10. (J) Infants and children with burns who were seen initially in centers without qualified personnel or proper equipment for burn care shall be transferred to a burn center with those capabilities; or
   11. (K) Burn injury in patients who will require special social and emotional or long-term rehabilitative support, including cases involving suspected abuse and neglect; and

3. (3) Pediatric patient.

   1. (A) A hemodynamically unstable pediatric patient not responsive to standard resuscitative techniques mandates immediate operative intervention.
   2. (B) Nonoperative care is safe only in an environment that provides both close clinical observation by a surgeon experienced in the management of childhood trauma and promptly available medical care.
   3. (C) A pediatric patient presenting with any one (1) of the following criteria shall be considered a candidate for rapid transfer to a facility capable of providing specialized pediatric care:

(i) GCS of less than or equal to thirteen (≤13) or GCS deterioration of two (2) or more;

1. (ii) Infants and children with injuries requiring complex or extensive reconstruction;

   1. (iii) Infants and children with polysystem trauma requiring organ system support;

      1. (iv) Infants or children who meet any of the adult transfer criteria as outlined in 20 CAR § 80-305; or
      2. (v) Hemodynamically stable infants and children with documented visceral injury being considered for observational management.