2015/02/17 by Douglas F. Kupas, Ellen Schenk, Jonathan Sholl +1 · 1 citation
Medicine · #Trauma and Emergency Care Studies #Cardiac Arrest and Resuscitation #Emergency and Acute Care Studies
paper · doi:10.3109/10903127.2014.964891
openalex publication_date 2015/02/17 · openalex created_date 2025/10/10 · openalex updated_date 2026/07/30
Douglas F. Kupas MD*, Ellen Schenk MPH, J. Matthew Sholl MD & Richard Kamin MDReceived March 12, 2014 from the Department of Emergency Medicine, Geisinger Health System, Danville, Pennsylvania (DFK), Rollins School of Public Health, Emory University, Atlanta, Georgia (ES), Department of Emergency Medicine, Maine Medical Center, Portland, Maine (JMS), and Department of Emergency Medicine, University of Connecticut Health Center, Farmington, Connecticut (RK). Revision received August 22, 2014; accepted for publication August 22, 2014.The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper.The authors would like to thank the members of the National Association of State EMS Officials (NASEMSO) and the NASEMSO Medical Directors Council for their assistance in survey completion and data verification. The authors would like to thank Cathy Gotschall, ScD, from the Office of Emergency Medical Services of the National Highway Traffic Safety Administration for her thoughtful review of the manuscript.Address correspondence to Douglas F. Kupas, MD, Department of Emergency Medicine, Geisinger Health System, 100 N. Academy Ave., Danville, PA 17822-2005, USA. E-mail: [email protected]. We sought to categorize and characterize the utilization of statewide emergency medical services (EMS) protocols as well as state recognition of specialty receiving facilities for trauma and time-sensitive conditions in the United States. Methods. A survey of all state EMS offices was conducted to determine which states use mandatory or model statewide EMS protocols and to characterize these protocols based on the process for authorizing such protocols. The survey also inquired as to which states formally recognize specialty receiving facilities for trauma, STEMI, stroke, cardiac arrest, and burn as well as whether or not states have mandatory or model statewide destination protocols for these specialty centers. Results. Thirty-eight states were found to have either mandatory or model statewide EMS protocols. Twenty-one states had mandatory statewide EMS protocols at either the basic life support (BLS) or advanced life support (ALS) level, and in 16 of these states, mandatory protocols covered both BLS and ALS levels of care. Seventeen states had model statewide protocols at either the BLS or ALS level, and in 14 of these states, the model protocols covered both BLS and ALS levels of care. Twenty states had separate protocols for the care of pediatric patients, while 18 states combined pediatric and adult care within the same protocols. When identified, the median age used to consider a patient for pediatric care was ≤14 years (range ≤8 to ≤17 years). Three states’ protocols used a child's height based on a length-based dosage tool as the threshold for identifying a pediatric patient for care using their pediatric protocols. States varied in recognition of receiving centers for EMS patients with special medical needs: 46 recognized trauma centers, 25 recognized burn centers, 22 recognized stroke centers, 11 recognized centers capable of percutaneous coronary intervention for ST-elevation myocardial infarction, and 3 recognized centers for patients surviving cardiac arrest. Conclusion. Statewide mandated EMS treatment protocols exist in 21 states, and optional model protocol guidelines are provided by 17 states. There is wide variation in the format and characteristics of these protocols and the recognition of specialty receiving centers for patients with time-sensitive illnesses.