UTSW/BioTel EMS Alert 15-004

Transporting BOTH a Pediatric Patient and an Adult Patient in One Ambulance to New Parkland Hospital

August 20, 2015

Purpose:

To notify UTSW/BioTel EMS Providers that, with the opening of NEW PARKLAND HOSPITAL (NPH) on August 20, 2015, if they transport BOTH an Adult patient AND a
Pediatric patient in one ambulance to NPH, BOTH patients MUST be off-loaded and shall be evaluated at the NPH Emergency Department.

Background:

1. Federal EMTALA regulations define a patient as having “come to the Emergency Department” when an ambulance crosses the threshold of that hospital’s property.
   
2. Historically, because Old Parkland Hospital and Children’s Health Dallas (previously Children’s Medical Center Dallas) shared a common hallway, EMS Providers were permitted
   to “split” an Adult and a Pediatric patient transported in the same ambulance. The Adult patient would be evaluated at the Old Parkland Hospital, and the Pediatric patient
   would be evaluated at Children’s Health Dallas.
   
3. The opening of the New Parkland Hospital on August 20, 2015 means that Children’s Health Dallas is now several blocks away and the old procedure is no longer feasible.
   
4. This requires revision of EMS patient off-loading procedures when transporting both an Adult patient and Pediatric patient in the same ambulance.
   
5. UTSW BioTel/EMS System Guidelines for Therapy definition of a Pediatric patient:
   
1. Trauma: Patient under 14 years of age (p.100 of 2014-2016 EMS Guidelines)
2. Medical: Patient under 19 years of age (p.100)
   
3. Psychiatric: Patient under 13 years of age (p. 95)

Critical Points, Effective Immediately:

1. Any ambulance transporting BOTH an Adult patient AND a Pediatric patient to NEW PARKLAND HOSPITAL (NPH) MUST off-load BOTH patients at NPH for evaluation.
   
2. If physicians in the NPH Emergency Department determine that a Pediatric patient requires a higher level of care, NPH staff will arrange transport of the patient to Children’s
   Health Dallas.
   
3. Under NO circumstances shall EMS Providers off-load ONLY the Adult patient and then continue on to Children’s Health Dallas with the Pediatric patient.
   
4. The same is true for ambulances arriving at Children’s Health Dallas with BOTH a Pediatric patient and an Adult patient.
   
5. In that case, BOTH patients will need to be evaluated at Children’s Health Dallas. Children’s staff will arrange for transport of the Adult patient to NPH or another facility.

EMS Field Transport and Destination Decision-Making Considerations:

1. Unless extenuating circumstances, such as a Mass Casualty Incident, mandate otherwise, Adult patients and Pediatric patients should be transported separately to NPH and
   to Children’s Health Dallas, respectively.
   
   1. This is normally in the best interest of both patients.
      
2. Therefore, it should not be routinely necessary or advisable to simultaneously transport BOTH an Adult patient AND a Pediatric patient in the same ambulance.
   
3. In particular, EMS Providers shall transport Pediatric patients under 14 years of age and meeting Trauma Center Triage Criteria to Children’s Health Dallas, NOT to NEW
   PARKLAND HOSPITAL.
   
   1. Exception: Pediatric burn patients who do not meet Pediatric Trauma Center Triage Criteria should be transported to NPH, not to Children’s
      
4. Should there be ANY question or concern whether or not to transport both an Adult patient and a Pediatric patient to the same facility in one ambulance, EMS Providers
   shall immediately consult with their EMS Supervisor and/or BioTel.

BioTel Notification Procedures:

1. EMS Providers shall ALWAYS notify BioTel when en route either to NPH or to Children’s Health Dallas with BOTH an Adult patient AND a Pediatric patient in the
   same ambulance.
   
   1. These notification procedures amend the standard pre-hospital notification procedures already in place in the 2014-2016 UTSW/BioTel EMS Guidelines for Therapy.

SUMMARY:

1. The transport of BOTH an Adult patient AND a Pediatric patient in the same ambulance either to NPH or to Children’s Health Dallas is not routinely recommended.
   
2. EMS Providers who transport BOTH an Adult patient AND a Pediatric patient either to NPH or to Children’s Health Dallas in the same ambulance shall ALWAYS notify
   BioTel while en route.
   
3. EMS Providers MUST off-load BOTH patients for evaluation at the first receiving hospital Emergency Departments, either NPH or Children’s Health Dallas.
   
4. This Alert expands upon and, where applicable, supersedes relevant Destination Policy information in the current 2014-2016 UTSW/BioTel EMS Guidelines for Therapy,
   (pages 92-96 and pages 99-105 in the printed guidelines).

Resources (accessed August 19, 2015):

1. UTSW/BioTel EMS Guidelines for Therapy

UTSW/BioTel EMS Providers may contact Dr. Marshal Isaacs through BioTel, or at Marshal.Isaacs@utsouthwestern.edu, at any time with questions or concerns about this Alert.

The Parkland Health & Hospital System appreciates the selfless and lifesaving services you provide each day to patients in our North Texas communities.