EXCLUSION CRITERIA
The decision whether a patient can be safely transported to a non-emergency department facility/clinic/office is going to be difficult in some cases. The range of possible exclusions is vast and not entirely covered here. The paramedic will need to make a careful good faith1 judgement that the patient does not need the medical evaluation and intervention offered by an emergency department. The goal is to provide the patient with the most appropriate solution for their problem. Often this is a treat-in-place modality and not the emergency department. Take great care when evaluating patients who are in police custody and destined for detention and “medical clearance” is requested. The following exclusion criteria apply, and many patients retain their right to treatment and transport to an appropriate facility or refusal of such care.
1. Perform the fullest patient assessment that can be safely done and allowed by the patient.
2. Obtain as much information as possible as to the patient’s capacity (competence) to understand their problem, informed consent, and decisions for treatment and transport.
3. Determine if in the opinion of the paramedic the patient should be first evaluated in an emergency department before other dispositions are considered.
a. History of unstable or active disease that is time-sensitive and in need of evaluation and stabilization.
i. Possible traumatic brain injury (current or recent)
ii. Life or limb threatening trauma
iii. Exacerbations of chronic respiratory disease (asthma, COPD)
iv. Exacerbations or active cardiac disease (ischemia, failure, marked hypertension, marked hypotension, marked tachycardia, arrhythmias)
v. Undiagnosed abdominal or pelvic pain
vi. Possible risks to pregnancy
vii. Possible life-threatening overdose or intoxication
viii. Grossly abnormal vital signs including febrile conditions
ix. Any medical or traumatic issues not mentioned that concern the attending paramedic
4. In the event a decision is challenging it may be necessary to contact a physician for medical direction concerning transport to an emergency department.
5. Each potential health care facility, including Acute Behavioral Health Facilities and established mental health providers, will have exclusion criteria that will need to be assessed and determined on a case-by-case basis.
The decision whether a patient can be safely transported to a non-emergency department facility/clinic/office is going to be difficult in some cases. The range of possible exclusions is vast and not entirely covered here. The paramedic will need to make a careful good faith1 judgement that the patient does not need the medical evaluation and intervention offered by an emergency department. The goal is to provide the patient with the most appropriate solution for their problem. Often this is a treat-in-place modality and not the emergency department. Take great care when evaluating patients who are in police custody and destined for detention and “medical clearance” is requested. The following exclusion criteria apply, and many patients retain their right to treatment and transport to an appropriate facility or refusal of such care.
1. Perform the fullest patient assessment that can be safely done and allowed by the patient.
2. Obtain as much information as possible as to the patient’s capacity (competence) to understand their problem, informed consent, and decisions for treatment and transport.
3. Determine if in the opinion of the paramedic the patient should be first evaluated in an emergency department before other dispositions are considered.
a. History of unstable or active disease that is time-sensitive and in need of evaluation and stabilization.
i. Possible traumatic brain injury (current or recent)
ii. Life or limb threatening trauma
iii. Exacerbations of chronic respiratory disease (asthma, COPD)
iv. Exacerbations or active cardiac disease (ischemia, failure, marked hypertension, marked hypotension, marked tachycardia, arrhythmias)
v. Undiagnosed abdominal or pelvic pain
vi. Possible risks to pregnancy
vii. Possible life-threatening overdose or intoxication
viii. Grossly abnormal vital signs including febrile conditions
ix. Any medical or traumatic issues not mentioned that concern the attending paramedic
4. In the event a decision is challenging it may be necessary to contact a physician for medical direction concerning transport to an emergency department.
5. Each potential health care facility, including Acute Behavioral Health Facilities and established mental health providers, will have exclusion criteria that will need to be assessed and determined on a case-by-case basis.