Illinois Administrative Code › Title 77 - PUBLIC HEALTH › Part 515 - EMERGENCY MEDICAL SERVICES, TRAUMA CENTER, COMPREHENSIVE STROKE CENTER, PRIMARY STROKE CENTER AND ACUTE STROKE READY HOSPITAL CODE › Subpart K - COMPREHENSIVE STROKE CENTERS, PRIMARY STROKE CENTERS AND ACUTE STROKE-READY HOSPITALS › Appendix M - Inter-facility Pediatric Trauma and Critical Care Consultation and/or Transfer Guideline

Current through Register Vol. 48, No. 28, July 12, 2024
Introduction
Most ill and injured children can be successfully managed by
				  pediatricians, emergency physicians, and other community physicians in local
				  hospitals. However, certain types of severely ill or injured children may
				  require specialized pediatric critical care services or specialized trauma
				  services that are not generally available in local hospitals.
Referral centers that provide specialized pediatric critical
				  care services or specialized trauma services for pediatric patients should be
				  identified by community hospitals and local EMS agencies and included as
				  integral components of their pediatric emergency and critical care systems and
				  trauma care systems. The specialized referral centers provide 24-hour telephone
				  consultation to assist community physicians in the evaluation and management of
				  critically ill and injured children. In addition, most of these referral
				  centers provide pediatric inter-facility transport services to facilitate the
				  transport of critically ill or injured children to specialized centers when
				  indicated.
Decisions on when to seek consultation or to transfer
				  pediatric patients need to be individualized, based on local needs and
				  resources. However, children with certain categories of critical illness and
				  injury are at high risk of death and disability. Early consultation with
				  appropriate pediatric critical care or trauma specialists and rapid transport
				  to specialized referral centers, when indicated, can improve the outcomes for
				  these children. In particular, consultation shall be sought for pediatric
				  medical, surgical, and trauma patients who require intensive care when it is
				  not locally available.
The attached guidelines are intended for use in a number of
				  ways:
* They can be used by physicians and hospitals to identify
				  the types of critically ill or injured children who might benefit from
				  consultation with critical care or trauma specialists or transfer to
				  specialized referral centers. It is recommended that hospitals and their
				  medical staffs develop appropriate policies, procedures and staff education
				  programs based on these guidelines. This will help to promote consultation,
				  minimize delays, and facilitate appropriate, rapid and efficient transport of
				  critically ill and injured children to specialty centers, when
				  indicated.
* It is recommended that these guidelines also be used by
				  local EMS agencies as a basis for the development of pediatric consultation and
				  transfer guidelines based on the local needs and resources. Consultation and
				  transfer guidelines should be integrated into local EMS agency plans for
				  pediatric emergency, critical care, and trauma care in each region. These
				  guidelines should become specific EMS policies and procedures in order to
				  promote appropriate consultation and transfer of children who require
				  specialized pediatric critical care and/or trauma services.
The following guidelines are intended to assist physicians
				  and hospitals to identify the types of critically ill and injured children who
				  might benefit from consultation with pediatric critical care specialists or
				  trauma specialists and transfer to specialized pediatric critical care or
				  trauma centers, when indicated. If an inter-facility transport is required, the
				  referring physician, in consultation with the receiving physician, should
				  determine the method of transport and appropriate personnel to accompany the
				  child. The hospital shall have written pediatric inter-facility transfer
				  guidelines/policies/procedures concerning transfer of critically ill and
				  injured patients that include a defined process for initiation of transfer,
				  including the roles and responsibilities of the referring facility and referral
				  center; process for selecting the appropriate care facility; process for
				  selecting the appropriately staffed transport service to match the patient's
				  acuity level; process for patient transfer (including obtaining informed
				  consent); a plan for transfer of patient medical record information, signed
				  transport consent, and belongings; and a plan for provision of referral
				  institution information to family.
Consultation with pediatric medical and surgical specialists
				  at a pediatric tertiary care center or trauma specialists at a trauma center
				  should occur as soon as possible after evaluation of the patient. It is
				  recommended that each hospital and its medical staff develop appropriate
				  emergency department and inpatient guidelines, policies and procedures for
				  obtaining consultation and arranging transport, when indicated, for the
				  following types of pediatric medical and trauma patients.
I. Guidelines for Inter-facility Consultation and/or Transfer
				  for Evaluation of Pediatric Medical Patients (Non-trauma)
A. Physiologic Criteria
1. Depressed or deteriorating neurologic
				  status
2. Severe respiratory distress responding
				  inadequately to treatment and accompanied by any one of the following:
a. Cyanosis
b. Retractions (moderate to severe)
c. Apnea
d. Stridor (moderate to severe)
e. Grunting or gasping respirations
f. Status asthmaticus
g. Respiratory failure
3. Children requiring endotrachael intubation
				  and/or ventilatory support
4. Serious cardiac rhythm disturbances
5. Status post cardiopulmonary arrest
6. Heart failure
7. Shock responding inadequately to
				  treatment
8. Children requiring any one of the
				  following:
a. Arterial pressure monitoring
b. Central venous pressure or pulmonary artery
				  monitoring
c. Intracranial pressure monitoring
d. Vasoactive medications
9. Severe hypothermia or hyperthermia
10. Hepatic failure
11. Renal failure, acute or chronic requiring
				  immediate dialysis
B. Other Criteria
1. Near drowning with any history of loss of
				  consciousness, unstable vital signs or respiratory problems
2. Status epilepticus
3. Potentially dangerous envenomation
4. Potentially life-threatening ingestion of, or
				  exposure to, a toxic substance
5. Severe electrolyte imbalances
6. Severe metabolic disturbances
7. Severe dehydration
8. Potentially life-threatening infections,
				  including sepsis
9. Children requiring intensive care
10. Any child who may benefit from consultation
				  with, or transfer to, a pediatric critical care center
II. Guidelines for Interfacility Consultation and/or Transfer
				  for Evaluations of Pediatric Trauma Patients
A. Physiologic Criteria
1. Depressed or deteriorating neurologic
				  status
2. Respiratory distress or failure
3. Children requiring endotracheal intubation
				  and/or ventilatory support
4. Shock, compensated or uncompensated
5. Injuries requiring any blood transfusion
6. Children requiring any one of the
				  following:
a. Arterial pressure monitoring
b. Central venous pressure or pulmonary artery
				  monitoring
c. Intracranial pressure monitoring
d. Vasoactive medications
B. Anatomic Criteria
1. Fractures and deep penetrating wounds to an
				  extremity complicated by neurovascular or compartment injury
2. Fracture of two or more major long bones (i.e.,
				  femur, humerus)
3. Fracture of the axial skeleton
4. Spinal cord or column injuries
5. Traumatic amputation of an extremity with
				  potential for replantation
6. Head injury when accompanied by any of the
				  following:
a. Cerebrospinal fluid leaks
b. Open head injuries (excluding simple scalp
				  injuries)
c. Depressed skull fractures
d. Decreased level of consciousness
7. Significant penetrating wounds to the head,
				  neck, thorax, abdomen or pelvis
8. Major pelvic fractures
9. Significant blunt injury to the chest or
				  abdomen
C. Other Criteria
1. Children requiring intensive care
2. Any child who may benefit from consultation
				  with, or transfer to, a trauma center or a pediatric critical care
				  center
D. Burn Criteria - Contact should be made with a
				  burn center for children who meet any one of the following criteria:
1. Partial thickness burns of greater than 10%
				  total body surface area (TBSA)
2. Third degree burns in any age group
3. Burns involving:
a. Signs or symptoms of inhalation injury
b. Respiratory distress
c. The face
d. The ears (serious full-thickness burns or burns
				  involving the ear canal or drums)
e. The mouth and throat
f. The hands, feet, genitalia, major joints or
				  perineum
4. Electrical burns (including lightning
				  injury)
5. Chemical burns
6. Burns associated with trauma or complicating
				  medical conditions
7. Burned children in hospitals without qualified
				  personnel or equipment for the care of children
8. Burn injury in patients who will require
				  special social, emotional, or long-term rehabilitative intervention.