Section 325.136. Destination protocols.

Local MCA's shall develop and submit trauma destination protocols to the EMS and trauma section for review by the quality assurance task force, pursuant to MCL 333.20916. Upon review and approval by the department the MCA must formally adopt and implement the protocol. The following factors will be used in evaluating those destination protocols.

(a)    All trauma patients, as defined by the adult and pediatric trauma and triage criteria and methodology documents, should be transported to the closest appropriate state designated trauma center. There is not 1 single set of criteria that can define the appropriate trauma center for each area

of the state. Each region  will  need  to  determine  a   system  that   is appropriate for its specific situation.  The following factors may be used to assist in this process:

(i)   If a level 1 or 2 state designated trauma center is within 30 minutes transport time of the scene, the adult patient should be transported to the closest of these facilities.

(ii)    Pediatric trauma patients should be transported to a regionally designated facility for appropriate evaluation and stabilization and then transported to  the appropriate children's trauma center if needed. Parents should be transported to the same facility as their children if resources are available.

(b)    Bypassing a level 3 or 4 trauma center or a nonparticipating hospital is appropriate as long as the level 1 or 2 facility is within a reasonable distance from the scene, as defined by protocol.

(c)     Trauma patients  shall  not   be  transported   to  a  facility   not participating in the state trauma system unless there is no other reasonable alternative available. For example, the next closest facility is more than a reasonable distance from the scene.

(d)   Some areas of the state have prolonged transport times to any facility. Trauma patients in these areas shall be transported to the closest facility that can facilitate rapid transport to the definitive care facility.

(e)     In areas of the state where level 1 and 2 trauma centers are not within a reasonable distance from the scene, the trauma patient shall  be  transported  to  the closest appropriate highest level trauma center.

(f)   Each region shall carefully evaluate this situation since it could be detrimental to the patient to transport him/her to a level 4 center 30 minutes to the east, when the closest level 2 center is 40 minutes to the west. That patient would then have to be transported 70 minutes back to  the west after stabilization.

(g)   Protocols shall take into account the fact that some centers may have different resources available even though they are the same level.

(h)   Each region shall make appropriate determinations for destination based on what is best for the patient rather than based on politics or economic factors.

(i)   In areas of the state close to state borders, the most appropriate facility may be out of the state. Whenever possible, trauma patients shall be transported within state borders, but local protocols shall  address this issue.

History: 2007 AACS.