(a) Triage of traumatically injured patients.

1. (1) Licensed ambulance services shall appropriately triage all traumatically injured patients using the Field Triage Decision Scheme: The Arkansas Trauma Triage Protocol.

2. (2) The Lead EMSP will make the destination decision considering the:

   1. (A) Arkansas Trauma Communication Center (ATCC) recommendation;
   2. (B) Patient’s condition;
   3. (C) Distance of travel;
   4. (D) Patient preference; and
   5. (E) System status.

(b) Urgent trauma transfers.

1. (1)

   1. (A) The process for interfacility trauma transfers applies to those services participating in the state’s trauma system.
   2. (B) Services not participating shall have written protocols addressing procedures for the timely interfacility transfer of urgent trauma patients as defined below to appropriate adult or pediatric trauma centers based on the patient’s medical needs.
   3. (C) Any deviation from the service’s protocol shall be reviewed by the service’s medical director.

2. (2) The need for an urgent trauma transfer exists when, in the opinion of the treating physician, two (2) conditions are met:

   1. (A) The immediate needs of the patient cannot be met in the sending facility due to lack of capability or capacity; and
   2. (B) The patient’s condition is such that failure to meet the immediate needs will likely result in loss of life, limb, or fertility or permanent impairment that transfer to a higher level of care could potentially ameliorate.

3. (3)

   1. (A) The hospital seeking the urgent trauma transfer shall contact the ATCC to:

(i) Provide patient condition information; and

1. (ii) Obtain concurrence with the urgent trauma transfer classification.

   1. (B) All urgent trauma transfers shall prompt involvement of the medical director of ATCC in real time.

2. (4)

   1. (A) The medical director shall:

      1. (i) Verify the urgent nature of the transfer; and
      2. (ii) Concur there is reasonable evidence the two conditions of an urgent trauma transfer are met.
   2. (B) If the above conditions are met and concurrence from ATCC is obtained, this transfer qualifies as an urgent trauma transfer.

3. (5)

   1. (A) Once the ATCC confirms the patient meets the criteria for urgent trauma transfer, the ATCC shall contact the EMS service identified by the transferring hospital to coordinate pickup.

   2. (B) The ATCC shall:

      1. (i) Confirm with the transferring hospital the time the patient will be ready for pickup; and
      2. (ii) Communicate that to the EMS service.
   3. (C) The sending hospital should contact the EMS service designated on the ATCC dashboard early in the process to allow the service as much advance notice as possible of the impending urgent transfer.

4. (6)

   1. (A) If the EMS service cannot be at the transferring hospital by the agreed-upon time, a backfill service shall be contacted by the EMS service.
   2. (B) Service area coverage is considered in place at the time the backfill agreement request is accepted.
   3. (C) If the service is unable to secure a backfill agreement acceptance, the ATCC shall be available to assist with the backfill, but not to assume responsibility.

   4. (D) The EMS service shall:

      1. (i) Have ten (10) minutes to accept the transfer request; and
      2. (ii) Arrive at the hospital at the time agreed upon between the transferring hospital and the EMS service.
   5. (E) The patient and paperwork should be ready for transfer at that time.

5. (7)

   1. (A) All urgent trauma transfer requests shall prompt a review at the local Trauma Regional Advisory Council Performance Improvement (TRAC/PI) subcommittee to ensure that:

      1. (i) The system is being used appropriately;
      2. (ii) The urgent trauma transfer is accomplished in a timely manner; and
      3. (iii) Each segment of the system is performing its responsibilities.

   2. (B) Potential abuses of the system shall be elevated to the state TRAC/PI subcommittee of the Trauma Advisory Council for adjudication and recommendation of action steps to the Department of Health in order to prevent future abuses.

      1. (c) Nonurgent trauma transfers.
6. (1) If the transfer request does not meet the two (2) criteria for an urgent transfer, yet the patient’s injury requires a higher level of care, the transferring hospital shall call the ATCC to coordinate acceptance with the receiving hospital.

7. (2) The transferring hospital shall:

   1. (A) Notify its EMS service; and
   2. (B) Coordinate an appropriate time for patient pickup.
8. (3) The EMS service shall have no less than one (1) hour to arrive at the transferring facility.
9. (4) The transferring hospital shall have the patient ready for pickup by the agreed-upon time.