06/05/2026
Pennsylvania Department of Health
PATIENT DESTINATION – GROUND TRANSPORT
STATEWIDE BLS PROTOCOL
Purpose:
A. This protocol shall ensure that when a ground ambulance agency transports a patient in the
prehospital setting the patient is transported to the most appropriate receiving facility, while
considering the patient’s preference.
Criteria:
A. All patients, in the prehospital setting, who require ground ambulance transport to a receiving
facility.
Exclusion Criteria:
A. Interfacility transport – Patients who are being transported from one acute care hospital to another.
B. Deviation from protocol for this section is permitted when exigent or emergent situation exists.
Proper documentation must be provided.
Policy:
A. Patients transported from prehospital scenes
1 Transport to closest hospital.1 Unless specifically permitted by this protocol Patients transported
by ground ambulance shall be transported to the closest receiving facility unless any of the below
exceptions apply. For the purpose of this protocol, a reference to “closest receiving facility” shall
be construed to mean the licensed acute care hospital that is closest to the scene in terms of
estimated drive time.
2 Patient choice exception.3 There may be many reasons why a patient may choose one facility
over another, these may include but are not limited to, preexisting relationship with a physician, a
receiving facility, a medical service (e.g., a dialysis service), or a health insurance plan. Transport
by ground ambulance to a facility other than the closest receiving facility is permitted if the patient
or other person with legal authority to act for the patient (hereafter “legal representative”)4
expresses a preference for transport to a different facility. In the case of veterans, it is acceptable
to transport a patient to a veteran’s hospital that has an emergency department if the facility meets
other requirements of this patient choice exception. This is subject to the following:
a. The ground EMS crew may advise the patient or the patient’s legal representative that
he/she has a choice in destination, but the ground EMS crew may not suggest to a patient
that a more distant facility would be better for the patient, except for the conditions covered
by specific exceptions in this protocol. The exact level and capacity of any given licensed
acute care facility may change due to circumstances unknown to the EMS provider,
therefore it is not appropriate for the EMS provider or the EMS agency to exert their
preference into the patient destination decision.
b. The patient’s choice must be reasonable. EMS agencies are not required to transport
patients to more distant facilities to accommodate a patient’s choice if the additional
transport distance is not reasonable. EMS agencies should have a policy that defines which
receiving facilities are within a reasonable transport distance from their usual 911 response
area. Such a policy should balance the patient’s right to choose a facility that is not the
closest with excessive transport times that substantially decrease the ability of the EMS
agency to provide 911 coverage for their usual response area.
3 Multiple/mass casualty incidents (MCI). This does not imply that all patients in an MCI must be
transported to the closest hospital. At a mass casualty incident, individuals within the incident
command structure (e.g., transport officer) should communicate with receiving facilities to
determine the capacity for patients at each center and should distribute seriously ill patients as
appropriate.
Effective 03/31/2024
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Pennsylvania Department of Health
Operations
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4 Weather conditions exception. Severe weather conditions, as determined by the EMS vehicle
operator and crew or by the EMS agency management, may make it hazardous to transport the
patient to some of the agency’s usual receiving facilities. In this case, agencies may choose to
restrict transportation to the closest receiving facility that can be reached safely.
5 Category I or Category II Trauma Patient exception.3 Follow the Trauma Patient Destination
Protocol ( #180) for a patient that meets the Trauma Patient Destination Criteria for transport to an
accredited trauma center.
a. Contact medical command if the patient or a person with legal authority to act for the patient
refuses transport to the closest appropriate trauma center per Trauma Patient Destination
Protocol #180.
6 Burn exception. A ground ambulance may transport a patient with a burn to the closest verified
burn center if the patient has a serious burn as defined in the Statewide Burn Protocols ( #671/
#6071), the patient is believed to be stable for the anticipated transport time, and the difference in
transport time is reasonable. If transport to a trauma center is indicated by the Trauma Destination
Criteria in protocol #180, transport to an appropriate trauma center takes priority over a burn center.
7 STEMI exception.3 A ground ambulance may transport a patient with ECG evidence of an ST
elevation myocardial infarction to the closest receiving center capable of providing emergency
primary percutaneous coronary intervention (PPCI).
a. Follow Chest Pain/Suspected Acute Coronary Syndrome protocol # 501/5001.
b. Appropriate emergency PPCI centers include facilities with one of the following:
1) Facilities, licensed by the Department, that provide either a) open heart surgery
or b) percutaneous coronary intervention (PCI) with an exemption of requirement
for open heart surgery. Facilities that provide emergency PCI are expected to
provide these services 24 hours per day. NOTE – Facilities licensed to provide
only diagnostic cardiac catheterization are NOT appropriate destinations for
EMS patients with STEMI.
2) Facilities certified as a Primary Heart Attack Center by The Joint
Commission/American Heart Association or certified as a Chest Pain Center with
PPCI by the American College of Cardiology
c. It is reasonable to bypass a closer facility and transport directly to a center with emergency
PPCI capabilities if the ground transport time is < 45 minutes.
d. If facility capabilities are not known or if the EMS provider believes that the patient may not
be stable for the extended travel time to the closest center with PPCI capability, the EMS
provider should contact a medical command physician to assist with destination decision.
e. Contact medical command if the patient or a person with legal authority to act for the patient
refuses transport to the closest appropriate center with PPCI capabilities.
8 Stroke exception. 3 A ground ambulance may transport a patient with suspected acute stroke to
an acute stroke ready hospital, primary stroke center, thrombectomy-capable stroke center, or
comprehensive stroke center.
a. Follow Suspected Stroke protocol #706/7006.
b. The Department of Health maintains a listing of recognized stroke centers. Found at
https://www.health.pa.gov/topics/EMS/Pages/Recognized-Stroke-Centers.aspx
c. It is reasonable to bypass a closer facility and transport directly to the closest primary stroke
center, thrombectomy-capable stroke center, or comprehensive stroke center if the ground
transport time is < 45 minutes. Otherwise transport to an acute stroke ready hospital, if that
facility can be reached within 45 minutes.
Effective 03/31/2024
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Pennsylvania Department of Health
Operations
170 - BLS – Adult/Peds
d. If facility capabilities are not known or if the EMS provider believes that the patient may not
be stable for the extended travel time to the closest acute stroke ready hospital, primary
stroke center, thrombectomy-capable stroke center, or comprehensive stroke center, the
EMS provider should contact a medical command physician to assist with destination
decision.
e. Contact medical command if the patient or a person with legal authority to act for the patient
refuses transport to the closest appropriate stroke center.
9 Pediatric exception.3 A ground ambulance may transport a pediatric patient (14 years of age or
younger) to the closest receiving center with inpatient pediatric capabilities if the patient is believed
to be stable for the anticipated transport time and if the difference in transport time is reasonable.
10 Pregnancy exception. A ground ambulance may transport a patient with any pregnancy-related
complaint who is at or beyond 20 weeks gestational age to the closest receiving facility with a
licensed obstetrical care unit if the patient is believed to be stable for the anticipated transport time.
a. Follow Emergency Childbirth Protocol #781.
b. It is reasonable to bypass a closer facility and transport directly to the closest facility with
a licensed obstetrical care unit if the ground transport time is
Recognized Stroke Centers
