Policy 8 — Freestanding ERs

What decision must be confirmed before applying the Universal Patient Care protocol in the FEC transport algorithm?

Whether the patient requesting FEC transport meets all indication criteria listed

After confirming a patient meets FEC indication criteria and Universal Patient Care protocol is applied, what is checked next?

Whether all vital signs are within the specified range

What heart rate range must a patient be within to qualify for FEC transport?

60 to 130 bpm

What systolic BP range must a patient be within to qualify for FEC transport (pediatric BP determined by a separate chart)?

110 to 160 mmHg

What pulse oximetry value must a patient exceed to qualify for FEC transport?

Greater than 92%

What blood glucose range must a patient be within to qualify for FEC transport?

70 to 300 mg/dL

What GCS value is required to qualify for FEC transport?

GCS of 15

If a patient does not meet indication criteria or has vital signs outside the specified range, what should EMS tell the patient?

That they may need to be admitted to the hospital, surgical suite, or cath lab, and going to an FEC may delay their care — EMS strongly suggests transport to a hospital-based facility

What type of abdominal presentation is an appropriate indication for FEC transport?

Abdominal pain with normal vital signs

What GI symptoms are an appropriate indication for FEC transport?

Uncomplicated nausea, vomiting, and/or diarrhea

What general illness symptoms are an appropriate indication for FEC transport?

Flu-like symptoms, sore throat, minor respiratory infection, ear ache, cough, and/or rash

What urinary symptom is an appropriate indication for FEC transport?

Painful urination

What level of musculoskeletal injury is appropriate for FEC transport?

Uncomplicated musculoskeletal injuries up to and including closed fractures or dislocations, as long as the neurovascular system appears intact

What wound types are appropriate for FEC transport?

Lacerations and/or abrasions not requiring surgical intervention

What spinal-precaution status is required for FEC transport eligibility?

Patients in whom spinal precautions are not indicated

What trauma-activation status is required for FEC transport eligibility?

Trauma activation is not expected

What age range is a contraindication to FEC transport?

Younger than 2 years old or older than 64 years old

What cardiac presentations are contraindications to FEC transport?

STEMI or high-risk chest pain; chest pain or possible ACS in patients over 40 years old

What arrest types are contraindications to FEC transport?

Cardiac or traumatic arrest

What neurological presentation involving possible stroke is a contraindication to FEC transport?

Suspected stroke or stroke-like symptoms

What mental status finding is a contraindication to FEC transport?

Altered mental status

What gestational age is a contraindication to FEC transport?

Pregnancy over 20 weeks gestation

What general neurological concern is a contraindication to FEC transport?

Potential for neurologic involvement

What hemorrhage control intervention is a contraindication to FEC transport?

Hemorrhage requiring wound packing or tourniquet use

What penetrating trauma severity is a contraindication to FEC transport?

Significant penetrating trauma

What vascular extremity finding is a contraindication to FEC transport?

Ischemic extremities

What orthopedic injury findings are contraindications to FEC transport?

Angulated long bone or open fracture, or open joint dislocation

What spinal management need is a contraindication to FEC transport?

Spinal motion restriction is indicated

What non-clinical factors can also serve as contraindications to FEC transport?

Paramedic judgment, anticipated need for surgery, or suspected inpatient admission