Advanced Trauma Life Support ATLS Student Course Manual 2018

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CHAPTER 13 n Transfer to Definitive Care
Restrict spinal motion if indicated. Ensure the
receiving facility is capable of treating both
the mother and baby.
4. Central nervous system
a. Assist respiration in unconscious patients.
b. Administer mannitol or hypertonic saline, if
needed, when advised by the receiving doctor.
c. Restrict spinal motion in patients who have or
are suspected of having spine injuries.
5. Perform appropriate diagnostic studies (sophisticated
diagnostic studies, such as CT and
aortography, are usually not indicated; when
indicated, obtaining these studies should not
delay transfer).
a. Obtain x-rays of chest, pelvis, and extremities.
b. Obtain necessary blood work.
c. Determine cardiac rhythm and hemoglobin
saturation (electrocardiograph [ECG] and
pulse oximetry).
6. Wounds (Note: Do not delay transfer to carry out
these procedures.)
a. Clean and dress wounds after controlling
external hemorrhage.
b. Administer tetanus prophylaxis.
c. Administer antibiotics, when indicated.
7. Fractures
a. Apply appropriate splinting and traction.
The flurry of activity surrounding initial evaluation,
resuscitation, and preparations for transfer of trauma
patients often overrides other logistic details. This
situation may result in failure to include certain
information sent with the patient, such as x-ray films,
laboratory reports, and narrative descriptions of the
evaluation process and treatment rendered at the local
hospital. To ensure that all important components of
care have been addressed, use a checklist. Checklists
can be printed or stamped on an x-ray jacket or the
patient’s medical record to remind the referring doctor
to include all pertinent information. (See Transfer
Checklist on MyATLS mobile app.)
Treatment of combative and uncooperative patients
with an altered level of consciousness is difficult and
potentially hazardous. These patients often require
restriction of spinal motion and are placed in the
supine position with wrist/leg restraints. If sedation
is required, the patient should be intubated. Therefore,
before administering any sedation, the treating
doctor must: ensure that the patient’s ABCDEs are
Pitfall
Inadequate
handover between
treatment and
transferring teams
Inadequate
preparation
for transport,
increasing
the likelihood
of patient
deterioration
during transfer
appropriately managed; relieve the patient’s pain if
possible (e.g., splint fractures and administer small
doses of narcotics intravenously); and attempt to calm
and reassure the patient.
Remember, benzodiazepines, fentanyl (Sublimaze),
propofol (Diprivan), and ketamine (Ketaset) are all
hazardous in patients with hypovolemia, patients
who are intoxicated, and patients with head injuries.
Pain management, sedation, and intubation should
be accomplished by the individual most skilled
in these procedures. (See Chapter 2: Airway and
Ventilatory Management.)
The referring doctor and the receiving doctor hold
specific transfer responsibilities.
Referring Doctor
prevention
• Use a transfer checklist to
ensure that all key aspects of
care rendered are properly
communicated to the transfer
team.
• Verify that copies of medical
records and x-rays are prepared
and provided to the transfer team.
• Identify and initiate resuscitative
efforts for all life-threatening
conditions.
• Ensure that transfer agreements
are in place to enable rapid
determination of the best
receiving facility based on the
patient’s injuries.
• Confirm that all patient transport
equipment is pre-staged and
ready to go at all times.
Transfer Responsibilities
The referring doctor is responsible for initiating
transfer of the patient to the receiving institution
and selecting the appropriate mode of transportation
and level of care required for the patient’s optimal
treatment en route. The referring doctor should consult
with the receiving doctor and be thoroughly familiar
with the transporting agencies, their capabilities,
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