with professional organizations, convene a panel of individuals with multidisciplinary expertise to develop evidence-based model prehospital care protocols for the treatment, triage, and transport of patients (3.2). The transport protocols should also reflect the state of readiness of given facilities within a region at a particular point in time. Real-time, concurrent information on the availability of hospital resources and specialists should be furnished to EMS personnel to support transport decisions. Development of an initial set of model protocols should be completed within 18 months of the release of this report. These protocols would facilitate much more uniform treatment of injuries and illnesses nationwide so that all patients would receive the current standard of care at the most appropriate location. The protocols might require modification to reflect local resources, capabilities, and transport times; however, they would acknowledge the fact that the basic pathophysiology of human illness is the same in all areas of the country. Once in place, the national protocols could be tailored to local assets and needs. The process for updating the protocols will also be important because it will dictate how rapidly patients will receive the current standard of care.

The 1966 NAS/NRC report Accidental Death and Disability anticipated the need to categorize care facilities and improve transport decisions:

The patient must be transported to the emergency department best prepared for his particular problem…. Hospital emergency departments should be surveyed … to determine the numbers and types of emergency facilities necessary to provide optimal emergency treatment for the occupants of each region…. Once the required numbers and types of treatment facilities have been determined, it may be necessary to lessen the requirements at some institutions, increase them in others, and even redistribute resources to support space, equipment, and personnel in the major emergency facilities. Until patient, ambulance driver, and hospital staff are in accord as to what the patient might reasonably expect and what the staff of an emergency facility can logically be expected to administer, and until effective transportation and adequate communication are provided to deliver casualties to proper facilities, our present levels of knowledge cannot be applied to optimal care and little reduction in mortality and/or lasting disability can be expected. (NAS and NRC, 1966, p. 20)

These views were echoed in the 1993 Institute of Medicine (IOM) report Emergency Medical Services for Children, which stated that “categorization and regionalization are essential for full and effective operation of systems” (IOM, 1993, p. 171).

Once the decision has been made to transport a patient, the responding ambulance unit should be instructed—either by written protocol or by on-line medical direction—which hospital should receive the patient (see Figure 3-1). This instruction should be based on developed transport

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