Institutions, physicians and corporations have often built their Freestanding Emergency Centers (FEC) without discussing the FEC’s role with local EMS. This has forced many EMS agencies to adapt to the FECs in various ways.
Fear of the unknown has lead some EMS agencies to not include FEC’s in any of their patient transfer protocols. In other instances hospital systems have fought “tooth and nail” to keep EMS from delivering patients to FECs for fear that they may lose control over the monopoly these hospital systems have over EMS traffic. In some areas EMS will deliver 911 patients to hospital owned FECs (aka HOPDS) but will refuse to deliver 911 patients to privately owned FECs due to the political & economic pressures that hospital monopolies have applied to the EMS system. The legality and ethics of this practice have yet to be tested in the courts.
In other areas the FECs have been a welcomed addition to the EMS system and have greatly lessened the over crowding in hospital based emergency departments. In the areas where FECs have been utilized for 911 traffic, patients and EMS agencies have been able to enjoy faster transport and delivery times. Patients have also enjoyed the emergency care being closer to their homes and more easily supported by family members.
Since the Centers for Medicare and Medicaid Services (CMS) has not yet recognized physician- owned FECs as a emergency facilities- some fear that CMS may not reimburse these patient’s transport at the same rate as they would if they were delivered to a hospital based emergency department. This still remains to be discovered. As FECs become more common this will become known. Commercial insurance does recognize the privately owned facilities and therefore will reimburse EMS transport to privately owned FECs at industry standard transport rates.
FECs have the same equipment and personnel that hospital based emergency departments have. In fact, most FECs are staffed with only highly tenured caregivers who have had many years of experience in high acuity emergency departments and trauma centers. With even the most high acuity hospital based emergency departments “treating and streeting” nearly 90% of all their patients (including EMS traffic) it makes sense that delivering a majority of 911 patients to FECs is a safe and prudent practice. There are some patients however that may be better treated if they were not taken to the FEC and instead taken directly to the hospital based emergency department.
Many systems who utilize the FECs in their 911 transport protocols have come up with differing protocols. The staff at the Journal of Free Standing Emergency Medicine have analyzed many of these protocols. Based upon this analysis the following sample protocol for the delivery of 911 traffic to FECs was developed. Obviously, any such protocol should be developed via coordination of individual EMS agencies and individual FECs. This sample protocol should be modified to meet the specific needs and capabilities of both local EMS and the individual FEC in such a way that maximizes patient safety and improves patient outcomes. It is hoped that this sample protocol may serve as a nidus to spawn this conversation in those areas where EMS is still trying to develop how they may incorporate FECs into their transport protocols.
SAMPLE EMS FEC EMERGENCY TRANSPORT PROTOCOL
All 911 traffic may be transferred to the nearest emergency department including freestanding emergency departments with the following exceptions:
- Unstable Blunt, Penetrating or Multi-system trauma (needs to go to OR)
- Acute STEMI (needs to go to cath lab)
- Acute CVA (may need immediate intervention by specialist)
- Acute paralysis (may need immediate intervention by specialist)
- Unstable GI Bleed (may need immediate intervention and ICU)
- Intubated patients (needs ICU)
- Detox or combative psych patients (needs large # of staff to manage)
- Women in active labor, women >20 weeks pregnant with spotting, pelvic pain or with pelvic trauma (needs OB/fetal monitoring)
- Comatose patients (needs ICU)