Pennsylvania Department of Health Protocols - 170-BLS  Patient Destination - Ground Transport Statewide BLS Protocol. 

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Purpose: 

A. This protocol shall ensure that when a ground ambulance agency transports a patient in the prehospital setting the patient is transported to the most appropriate receiving facility, while considering the patients' s preference. 

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Policy:

1. Transport to closest hospital: Patients transported by ground ambulance shall be transported to the closest receiving facility unless any of the below exceptions apply. For the purpose of this protocol, a reference to “closest receiving facility” shall be construed to mean the licensed acute care hospital that is closest to the scene in terms of estimated drive time.

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2. Patient choice exception: There may be many reasons why a patient may choose one facility over another, these may include but are not limited to, preexisting relationship with a physician, a receiving facility, a medical service (e.g., a dialysis service), or a health insurance plan. Transport by ground ambulance to a facility other than the closest receiving facility is permitted if the patient or other person with legal authority to act for the patient (hereafter “legal representative”) expresses a preference for transport to a different facility.  In the case of veterans, it is acceptable to transport a patient to a veteran’s hospital that has an emergency department if the facility meets other requirements of this patient choice exception. This is subject to the following:

 

a. The ground EMS crew may advise the patient or the patient’s legal representative that he/she has a choice in destination, but the ground EMS crew may not suggest to a patient that a more distant facility would be better for the patient, except for the conditions covered by specific exceptions in this protocol. The exact level and capacity of any given licensed acute care facility may change due to circumstances unknown to the EMS provider, therefore it is not appropriate for the EMS provider or the EMS agency to exert their preference into the patient destination decision.

 

b. The patient’s choice must be reasonable. EMS agencies are not required to transport patients to more distant facilities to accommodate a patient’s choice if the additional transport distance is not reasonable. EMS agencies should have a policy that defines which receiving facilities are within a reasonable transport distance from their usual 911 response area. Such a policy should balance the patient’s right to choose a facility that is not the closest with excessive transport times that substantially decrease the ability of the EMS agency to provide 911 coverage for their usual response area.  ​​

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