b'Non-Ambulance Vehicle Interfacility Transport (NAVIT): A Safe, Patient-Centered Option for the Right ED PatientBy Avram Flamm, DO, FACEP; Stephanie Costa, MDFacial laceration: A 13-year-old with a complex lip laceration involving the vermilion border requires subspecialty repair but is otherwise stable. The injury occurred at 8:30pm and the patient was seen in the ED at 1am (after a long wait). The patient is accepted by OMFS (or plastic surgery) at a tertiary center which is a 50-minute drive away. EMS notify the ED the next available unit for this transport can arrive at 10am the next day. The patients parent who is bedside is a reliable parent Avram Flamm, DO, FACEP Stephanie Costa, MD who would like to drive to the tertiary PACEP EMS Committee Chair PACEP EMS Committee Vice Chair hospital in their private vehicle. After a discussion of risks and benefits with In todays emergency careand that medical oversight during transitthe patient, the emergency physician environmentmarked by crowded EDs,is not required, NAVIT can provide bothbelieves NAVIT is a safe transport EMS staffing shortages, long wait timesmedical appropriate and operationallymodality for this patient and they are for interfacility transport, and risingefficient transport alternatives. transported with their IV in place.costsnot every ED-to-ED or ED to Orthopedic injury: An adult with a hospital transfer requires an ambulance.REAL-WORLD SCENARIOS WHERE For carefully selected, clinically stableNAVIT IS REASONABLE complex ankle fracture, good pain patients, non-ambulance vehiclecontrol, and ability to ambulate withAppendicitis: A stable patientcrutches is accepted for orthopedic interfacility transport (NAVIT) offers a safe, appropriate, and patient-centereddiagnosed in a community ED withsurgery at a tertiary center. The injury alternative. uncomplicated appendicitis requiresoccurred at 6am this morning and the transfer to another hospital for surgicalpatient was seen at 8am. Orthopedics Ambulance transport remains theintervention. The patient has mildat the tertiary center, 20 min drive standard of care when patientsabdominal pain which is well controlled,away, plan to operate on the patient require medical monitoring, transportstable vitals, and can be trusted toearly afternoon timeframe and were in a stretcher, or the possibility ofremain NPO. The patient also has a safeable to secure an OR slot. The patient intervention en route. However, manydriver waiting bedside. Although thehas been NPO since yesterday at dinner. transfers involve patients who are stable,transport time is 35 minutes, EMS reportThe patient has stable vitals and pain is ambulatory, and simply need to reachtheir next available transporting unitwell controlled. EMS report it is a very a higher level of care or a specialistcan arrive in 10 hours. After a discussionbusy day and there were a few call-offs unavailable at the sending ED. Whenof risks and benefits with the patient,and next available transport is 7pm. a patient can travel safely in a seatedthe emergency physician believes NAVITThe patient is worried about losing position, and the sending emergencyis a safe transport modality for thistheir OR slot. After a discussion of risks physician determines that they are safepatient and they are transported withand benefits with the patient, the for interfacility transport (IFT) via NAVITtheir IV in place. emergency physician believes NAVIT 22 PACEP News | Fall 2025'