Destination Guidelines and Hospital Designation

Questions and Answers

1 Are there other important determinants of patient outcome besides assessment and treatment of a patient?

While prehospital assessment and interventions are important to patient care, the determination of where to transport is also critical. If there is only one available hospital, the choice is easy. However, if there are multiple potential facilities, the decision must be based on the patient’s medical needs. When a patient has a condition requiring treatment at a specialty receiving center (e.g., trauma, stroke, and ST-elevation myocardial infarction [STEMI]), it is important that providers recognize the condition and transport to the appropriate center. Similarly, prenotification to a receiving facility reduces in-hospital intervention times and may improve patient outcomes.

2 How do I know which hospital to go to?

This decision must be made on an individual basis. While some patients are appropriate for transport to the closest hospital, others will present with conditions requiring services provided by specialty centers, such as burns, STEMI, trauma, and stroke. Consequently, it becomes necessary to bypass the closest hospital in favor of a hospital meeting with specific capabilities. State, regional, or local destination protocols may provide guidance.

3 Are there national guidelines to help identify the correct hospital?

There are several organizations, including the American Burn Association, American Heart Association, American College of Surgeons, and American Stroke Association, which determine criteria required for hospitals to provide optimal care to specific patient groups (burns, STEMI, trauma, and stroke, respectively). In conjunction with the Joint Commission, these organizations ensure that hospitals with specialty designations remain prepared to provide care to these patients.

4 What factors determine whether a trauma patient should be transported emergently to a trauma center?

The Centers for Disease Control has developed guidelines to determine which patients require transport to a trauma center. These guidelines, entitled “Guidelines for Field Triage of Injured Patients,” direct the care of individual patients as well as establishment of trauma criteria by trauma centers. The criteria are divided into four categories: physiologic, anatomic, mechanism of injury, and special considerations.

5 What is a level I trauma center and how does it differ from level II, III, and IV trauma centers?

Trauma center designation criteria vary based on state; however, there are several common elements. A level I trauma center is capable of providing care for every aspect of patient injury, requiring 24-hour coverage by trauma surgeons and all surgical and medical subspecialty services. Level II centers have fewer subspecialties available, although they retain 24-hour coverage by the majority of services. Level III centers are capable of 24-hour care by emergency medicine, general surgery, and anesthesia. Level IV centers can provide Adult Trauma Life Support care to trauma patients prior to transfer to a facility with greater trauma capabilities.

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