(a) The Division adopts the standards listed in this subsection. These standards shall control except as otherwise provided in this chapter. The adoption of these standards does not include later amendments or editions of the incorporated matters and shall not be interpreted as adding to or subtracting from the scope of practice for EMS providers. EMS agencies and EMS providers shall incorporate these standards into their local system design to the extent possible. - (i) The triage decision scheme for trauma patients shall be U. S. Dep't of Health and Human Servs., Ctrs. for Disease Control and Prevention, Guidelines for Field Triage of Injured Patients (2012). Copies are available from the Division upon request, and may be obtained through the CDC at: http://www.cdc.gov/mmwr/pdf/rr/rr6101.pdf.
- (ii) The basis for the development of local systems of cardiac care shall be Am. Heart Ass'n, 2015 Guidelines for CPR and ECC(2015). Copies are available from the Division upon request, and may be obtained through the AHA at: https://eccguidelines.heart.org/index.php/circulation/cpr-ecc-guidelines-2/.
- (iii) The basis for the development of local systems of stroke care and evidence based prehospital care protocols shall be:
- (A) Am. Heart Ass'n & Am. Stroke Ass'n, Guidelines for the Early Management of Patients with Acute Ischemic Stroke(2013); copies are available from the Division upon request, and may be obtained through the AHA at: http://stroke.ahajournals.Org/content/44/3/870.full.pdf+htmland; and
- (B) Am. Heart Ass'n & Am. Stroke Ass'n, 2015 AHA/ASA Focused Update of the 2013 Guidelines for the Early Management of Patients with Acute Ischemic Stroke Regarding Endovascular Treatment(2015); copies are available from the Division upon request, and may be obtained through the AHA at: http://stroke.ahajovimals.org/content/early/2015/06/26/STR.0000000000000074.full.pdf+html.
(b) EMS agency operations shall be conducted in accordance with the standards adopted in subsection (a) of this section and in accordance with the following principles: - (i) Ambulances shall transport patients to the facility best suited to care for the patient suffering a TSE, based on achieving the following principles:
- (A) Transport of the trauma patient to a Trauma Center within one (1) hour of the time of injury;
- (B) Transport of the patient suffering an acute heart attack to a facility with the capability to perform cardiac percutaneous coronary intervention (PCI) that minimizes the time between the onset of symptoms and the PCI procedure. Current evidence shows improved clinical outcomes when the PCI is performed less than 90 minutes from the onset of symptoms;
- (C) Transport of the patient suffering an acute stroke to a primary or comprehensive stroke center as soon as possible. Current evidence indicates that the effective treatment window for the acute stroke patient is up to six hours.
- (ii) The times listed in subsection (b)(i)(A)-(C) reflect benchmarks for ideal care. Patients may still benefit from transport to or treatment by a higher level TSE facility when these times are exceeded.
- (iii) The bypass of a facility in favor of a facility with a higher capability shall be considered even if the required transport time exceeds that of the transport time to a closer facility. Factors influencing the decision to bypass include, but are not limited to:
- (A) The additional time required to reach the facility with higher capability;
- (B) The stability of the patient's condition;
- (C) The scope of practice of the EMS providers and their capabilities for management of the TSE;
- (D) The time that will be expended at the initial facility prior to the transfer of the patient.
(c) EMS agencies shall adopt in writing: - (i) Evidence-based prehospital care protocols using the standards adopted in subsection (a) of this section;
- (ii) Operational procedures that address the requirements of this chapter and incorporate the principles of section 3(b) within the specific resources of the local community and region. The operational procedures shall include, but are not limited to:
- (A) Procedures for limiting the scene time for each TSE;
- (B) Procedures for assessing the incident scene to determine:
- (I) Hazards to EMS providers, the patient, and bystanders;
- (II) The number of patients and the mechanism of injury;
- (III) The need for additional resources and the benefits and risks of waiting for additional resources rather than providing rapid transport to definitive care;
- (IV) The need to declare a mass casualty incident;
- (C) The proximity of hospitals and TSE facilities relative to the EMS response area and their specific capability to treat a TSE;
- (D) Decisional boundaries where the transport of a patient to a TSE specific facility may prove to be beneficial to a patient experiencing a TSE;
- (E) Procedures for the intercept of an ambulance service by another ambulance service capable of providing a higher level of care;
- (F) The optimal course of action for the treatment and transport of a TSE during normal, day-to-day operations;
- (G) Alternative courses of action that address circumstances under which the optimal course of action is prohibited or would not prove of benefit to the patient including, but not limited to:
- (I) Adverse weather conditions;
- (II) Permanent or temporary factors that increase the time required to transport a patient to the ideal TSE facility such as road closures;
- (III) Closure of or non-availability of the optimal TSE facility due to compromised infrastructure or loss of specialized equipment, personnel, or resources;
- (IV) Transport to alternative destinations in the event of mass-casualty incidents or public health emergencies.
- (H) The means and circumstances for requesting additional resources;
- (I) Standardized methods of notifying receiving facilities of the arrival of a possible TSE as soon as practicable;
- (J) The means and circumstances for requesting the dispatch of air medical resources to the scene to facilitate rapid transport.
(d) An EMS agency shall not prohibit EMS providers from requesting an air ambulance transport from the field.
048-15 Wyo. Code R. § 15-3