Freestanding Emergency Department Destination Policy

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History: This an example policy that may be used in your EMS system



The purpose of this protocol is to describe the authorized procedures to be followed when selecting to transport to a Freestanding Emergency Department (FSED). As always, the system’s goal is to transport patients to the “most appropriate” Emergency Department. This protocol describes how to determine if a FSED is the “most appropriate” destination.



A Freestanding Emergency Department is a facility licensed under but physically separate from a general hospital; it may use in its title or advertising the words “emergency”, “urgent care”, or parts of those words or language which imply or indicate to the public that immediate medical treatment is available to individuals suffering from a life threatening medical condition. Freestanding ED’s must meet the same construction, staffing, and equipment criteria as general hospital Emergency Departments. With the exception of serious trauma, they must offer the same services as traditional ED’s, are open 24 hours a day, and are accompanied by ancillary services; however, patients requiring hospitalization must be transferred out to a local hospital. These facilities may make ED services available without the protracted wait times we see in today’s crowded traditional ED’s.


Transport Guidelines

Transport Exceptions: The following types of patients are NOT candidates for transport to a FSED unless necessary in a disaster situation:

1.Severity “Red” patients, indicating unstable vital signs or other life- threatening conditions UNLESS the patient’s airway is not maintainable with EMS advanced or basic airway management techniques and the FSED is the closest ED.

2.Traumatic or Medical Cardiac Arrest patients, UNLESS the patient’s airway is not maintainable as above.

3.Patients meeting Trauma Alert or Trauma Center Destination Criteria

4.STEMI Alert patients

5.Brain Attack Alert patients

6.Other likely Neurosurgical candidate patients

7.Pregnant women at greater than 20 weeks gestation with abdominal, chest 
or back pain or obviously in labor

8.Patients with symptoms of an ischemic extremity (pain, pallor, 

9.Patients with angulated longbone fractures

10.Patients with suspected open longbone fractures or dislocations

11.Patients requiring hard restraints or chemical sedation or patients in need of emergent psychological consultation


Severity “Green” patients who are experiencing minor injury or illness may be transported to a Freestanding Emergency Department. Examples include:

  • Uncomplicated symptoms such as chest pain, abdominal pain, shortness of breath, flu-like symptoms, sore throats, respiratory infections, rashes, fever, urinary symptoms, and uncomplicated nosebleeds.
  • Uncomplicated musculoskeletal injuries, including bruises, lacerations, sprains, back pain and closed suspected fractures or dislocations with intact neurovascular status
  • Spinal motion restricted patients who are triaged as Severity “Green” by EMS and who do not meet Trauma Alert or Trauma Center Destination Criteria. 
All other transport destination criteria, such as Bypass or Diversion Status at the FSED, will be treated identically to other Emergency Departments. Contact EMS Control for high-risk refusal if the patient insists on transport to the facility against EMS protocol.

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