BLS transport may be considered in life-threatening situations, if ALS response time is longer than BLS transport time (L.A. County Reference #808).  The following conditions may be transported by a BLS unit, however, an initial assessment, focused history and detailed physical exam should be performed to confirm that signs and symptoms of shock or other serious signs and symptoms are not present (L.A. County Reference #808)

·          Abdominal pain

·          Syncope or loss of consciousness prior to EMS arrival

·          Suspected allergic reaction

·          Near drowning

·          Minor burns <20% in adults, <15% in children, and <10% in infants

·          Thermal burns <20% in adults, <15% in children and <10% in infants

·          Asymptomatic exposure to chemical agents known to have delayed symptoms

·          Patients who are a danger to themselves or others (no evidence of ingestion of poisonous substances)

·          Gastrointestinal bleeding

·          Abnormal vaginal bleeding

Suspected isolated fractures of spine, skull or hip

A patient in shock should be transported immediately.  A focused history and detailed physical exam can be completed enroute.

ALS transport to the closest receiving hospital (L.A. County Reference #808)

·          Cardiopulmonary arrest (unless mechanism is a penetrating torso injury)

·          Patients whom the base hospital physician determines would be jeopardized by transport to any but the most accessible receiving hospital

·          Chest pain or discomfort

·          Shortness of breath/tachypnea

·          Obstructed airway

·          Hypotension BP< 90

·          Symptomatic hypertension

·          Altered level of consciousness (L.A. County Reference #809)

·          Suspected ingestion of poisonous substances

·          Exposure to Haz-mat with a medical complaint

·          Abdominal pain in pregnancy or suspected pregnancy

The decision to transport patients to designated trauma hospitals should be based on criteria and guidelines established in L.A. County reference #506-Trauma Triage. 

“Mechanism of injury is the most effective method of selecting critically injured patients before unstable vital signs develop.  Paramedics and base hospital personnel should consider mechanism of injury when determining patient destination” (L.A. County Reference #506, Policy II)

BLS transport may be considered in life-threatening situations, if ALS response time is longer than BLS transport time (L.A. County Reference #808). 

A BLS unit may transport the following conditions, however, a thorough initial assessment, focused history and detailed physical exam should be performed to confirm that signs and symptoms of shock are not present (L.A. County Reference #808)

·          Suspected isolated fractures of the spine, skull or hip

·          Syncope or loss of consciousness prior to EMS personnel arrival

·          Minor burns that do NOT involve the face or neck

·          Thermal burns <20% in adults, <15% in children and <10% in infants

·          Asymptomatic exposure to chemical agents known to have delayed symptoms

·          Minor wounds if circulation is not impaired and there are no signs of shock

A patient in shock should be transported immediately.  A focused history and detailed physical exam can be completed enroute.

ALS transport to Trauma Center (L.A. County reference #506)

• Trauma patients with the following blood pressures:

            < 7 years with a BP < 70 systolic

            > 7 years with a BP < 90 systolic

• Extremity injuries with neuro and/or vascular compromise
• Abnormal capillary refill
• Penetrating cranial injury
• Penetrating thoracic injurie between the midclavicular lines
• GSW to the trunk
• Penetrating neck injuries
• Traumatic full arrest with penetrating torso injury

• Patients surviving falls > 15 feet
• GCS of 14 or less, seizures, unequal pupils or neurological deficits following blunt head trauma
• Passenger space intrusion
• Blunt injury to the chest with unstable chest wall
• Open or closed injury to the spinal column associated with sensory deficit or weakness of one or more extremities
• Patient meeting above criteria, but in extremis, ALS to Closest Receiving hospital
• A burn patient in shock should be transported immediately.  Initial assessment, focused history and detailed physical exam can be completed enroute.
• A burn patient with an obstructed airway or cardiopulmonary arrest should be transported immediately to the most accessible receiving hospital.
• An adult burn patient should be transported to the most accessible receiving hospital for stabilization and medical evaluation (L.A. County Reference #506)
• ALS transport to the designated trauma center is indicated if there are associated injuries meeting trauma center criteria or guidelines and the patients condition would not be compromised by additional transport time (L.A. County Reference #510)
• Electrical burns should receive ALS transport due to the potential for cardiac dysrhythmias

BLS transport may be considered in life threatening situations, if ALS response time is longer than BLS transport time (L.A. County Reference #808)

The following conditions may be transported to the EDAP (Emergency Department Approved for Pediatrics) by a BLS unit, however, a thorough initial assessment, focused history and detailed physical exam should be performed to confirm that signs and symptoms of shock are not present (L.A. County Reference #808)

·          Isolated extremity injuries

·          Minor contusions, bruises, abrasions and lacerations

A patient in shock should be transported immediately; focused history and detailed physical exam can be completed enroute.

All children meeting PCCC criteria shall be transported by ALS (L.A. County Reference #510)

ALS transport to Trauma Center PCCC (L.A. County Reference #506)

• < 6 years with a BP < 70 systolic
• > 7 years with a BP < 90 systolic

BLS transport may be considered in life threatening situations, if ALS response time is longer than BLS transport time (L.A. County Reference #808)

·          Patients who are a danger to themselves or others

A patient in shock should be transported immediately; focused history and detailed physical exam can be completed enroute.

ALS Transport to the Closest Receiving Hospital (L.A. County Reference #808)

ALS Transport to the designated Trauma Center (L.A. County Reference #506)

BLS transport may be considered in life threatening situations, if ALS response time is longer than BLS transport time (L.A. County Reference #808)

A BLS unit may transport the following conditions, however, a thorough initial assessment, focused history and detailed physical exam should be performed to confirm that signs and symptoms of shock are not present (L.A. County Reference #808):

·          Abdominal Pain

·          Suspected isolated fractures to the spine, skull or hip

·          It is common for law enforcement officers to transport sexual assault victims who deny injuries and exhibit no signs of shock

ALS Transport to the Most Accessible receiving hospital (L.A. County Reference #808)

·          Patients exhibiting signs and symptoms of shock

·          Sexual assault victims must receive appropriate medical treatment for significant or life threatening injuries suffered in the alleged attack prior to evidence collection and are therefore transported to the Most Accessible Receiving Hospital for medical clearance.  Arrangements will be made for evidence collection with the local law enforcement agency.