Dispatch and Destination, On-scene, and Transportation

• All regions should have an organized trauma care system with comprehensive documentation of each encounter including time, assessment, and care provided.
• Emergency Medical Services (EMS) should establish specific protocols directing destination decisions for patients with suspected traumatic brain injury (TBI).
  • Pediatric patients with suspected TBI should be treated in a pediatric trauma center or in an adult trauma center with added qualifications

    to treat children in preference to a Level I or II adult trauma center without added qualifications for pediatric treatment.

• Patients with suspected moderate-severe TBI should be transported directly to a facility with immediately available computed tomography (CT) neuroimaging capabilities, prompt neurosurgical care, and the ability to monitor intracranial pressure and treat intracranial hypertension.
  • While direct transport to a trauma center is preferable for most patients, in the event that this transport is not possible, stabilization at a non-trauma center with subsequent transfer within an established trauma system may occur.
  • In a metropolitan area, pediatric patients with severe TBI should be transported directly to a pediatric trauma center if available.
  • The mode of transport should be selected to minimize the time to definitive interventions for the patient with TBI.[/sidebar]