NAC450B.770. Procedures for initial identification and care of patients with traumas.

A licensee providing emergency medical care to a patient at the scene of an injury shall use the following procedures to identify and care for patients with traumas:

     1. Step 1: If the patient’s:

     (a) Score on the Glasgow Coma Scale or, if the patient is a pediatric patient, his or her score on the modified Glasgow Coma Scale is not more than 13;

     (b) Systolic blood pressure is less than 90;

     (c) Respiratory rate is less than 10 or greater than 29; or

     (d) Revised trauma score is less than 11,

Ê the patient must be transported to a center for the treatment of trauma. If the patient is not required to be transported, the licensee providing emergency medical care shall assess the patient’s condition based upon the degree of injury to the anatomy and the mode of injury.

     2. Step 2: If the patient:

     (a) Has a penetrating injury to the head, neck, torso or the extremities proximal to the elbow or knee;

     (b) Has at least two proximal long bone fractures;

     (c) Has a fracture of the pelvis;

     (d) Has a combination of trauma with burns;

     (e) Has a flail chest;

     (f) Has an amputation proximal to the wrist or ankle;

     (g) Has acute paralysis;

     (h) Has an open and depressed fracture of the skull; or

     (i) Has major burns,

Ê the patient must be transported to a center for the treatment of trauma. If the patient is not required to be transported, the licensee providing emergency medical care shall evaluate the patient to determine the method of injury and the existence of any high-energy impact.

     3. Step 3: If the patient has experienced a high-impact blow to the body which may include:

     (a) A fall of at least 20 feet;

     (b) A motor vehicle accident in which:

          (1) The motor vehicle was traveling at a speed of at least 20 miles per hour immediately before the accident occurred;

          (2) There was at least 20 inches of severe damage to the body of the motor vehicle;

          (3) There was a 12-inch intrusion into the passenger’s compartment;

          (4) The patient was ejected from the motor vehicle;

          (5) The period required to extricate the patient from the motor vehicle was more than 20 minutes;

          (6) The motor vehicle rolled over;

          (7) A person riding in the motor vehicle with the patient died as a result of the accident;

          (8) The patient was riding on a motorcycle that was traveling at a speed of at least 20 miles per hour when the accident occurred; or

          (9) The patient was thrown from a motorcycle driven by him or her;

     (c) As a pedestrian, being run over by a vehicle or thrown any distance by the impact of a vehicle, regardless of the rate of speed of the vehicle; or

     (d) Being struck as a pedestrian or bicyclist by a vehicle traveling at a speed of at least 6 miles per hour,

Ê the patient must be transported to a center for the treatment of trauma.

     4. Step 4: If the patient is less than 5 years of age or more than 55 years of age or is known to:

     (a) Have a cardiac or respiratory disease;

     (b) Have insulin-dependent diabetes;

     (c) Have cirrhosis;

     (d) Be morbidly obese;

     (e) Be pregnant;

     (f) Have a suppressed immune system;

     (g) Have a bleeding disorder; or

     (h) Be taking any anticoagulant,

Ê the licensee providing emergency medical care shall communicate with a physician at a center for the treatment of trauma or comply with any local protocol approved by the Health Division to determine the need to transport the patient to that center.

     5. If the licensee providing emergency medical care is not certain whether to transport the patient to a center for the treatment of trauma, the licensee shall transport the patient to a center pursuant to NAC 450B.772.

     (Added to NAC by Bd. of Health, eff. 3-15-88; A by R182-01, 3-5-2002)