Directions:  Patient must be transported at the highest level of care required and matched to the capability of the transport vehicle/staff.
		BLS	Gurney Van	Wheelchair Van
1	Alert, oriented, able to communicate or has own attendant			X
2	Does not need constant supervision or require physical restraints			X
3	Not a danger to self or others			X
4	Must be transported by wheelchair with no stairs/steps to climb			X
5	Patient has no other means for transport and cannot go by taxicab			X
6	May carry and/or use own small portable 02 cylinder during transport			X
7	Destination has no wheelchair access or patient needs help to climb stairs		X
8	Disoriented, requires assistance/supervision and does not have own attendant	X*	X*
9	Unsafe standing, pivoting or ambulating	X*	X*
10	Must lie down or be semi-reclining	X*	X*
11	Head needs elevation and cannot sit	X*	X*
12	Requires constant observation – may be danger to self or others	X
13	Physical restraints and/or special positioning of extremities	X
14	Partial paralysis or semi-conscious	X
15	DNR documented	X
16	Complete paralysis or comatose	X
17	Continuous 02 and not patient’s own cylinder	X
18	Aspiration precautions	X
19	TKO or plain IV, Normal Saline Only	X
20	N-tube, G-tube, heparin lock, catheters, clamped indwelling vascular lines	X
21	Monitor central line with no medications	X
22	Isolation precautions, MRSA, VRE	X
	X* Indicates either BLS or Gurney Van