Advanced Trauma Life Support ATLS Student Course Manual 2018

248
CHAPTER 13 n Transfer to Definitive Care
Pitfall
prevention
Inadequate or inappropriate
communication
between referring and
receiving providers,
resulting in loss of
information critical to
the patient’s care
• Initiate call early in treatment
process, that is, upon identifying
the need to transfer to
definitive care.
• Specify all injuries identified,
emphasizing life-threatening
conditions.
• Provide all pertinent information
regarding the patient’s injuries,
care received, patient’s
response to care, and reason
for transfer.
n FIGURE 13-3 Trauma team receiving patient transferred by air.
capabilities. Transport teams should be familiar with
the safe transport of pediatric patients, including the
need for airway management, medication dosing, and
resuscitative adjuncts.
Receiving Doctor
The receiving doctor must be consulted to ensure that
the proposed receiving institution is qualified, able, and
willing to accept the patient and agrees with the intent
to transfer. The receiving doctor assists the referring
doctor in arranging for the appropriate mode and level
of care during transport. If the proposed receiving
doctor and facility are unable to accept the patient,
they can assist in finding an alternative placement
for the patient.
The quality of care rendered en route is vital to the
patient’s outcome. Only by directly communicating
can the referring and receiving doctors clearly outline
the details of patient transfer.
Modes of Transportation
When choosing the mode of patient transportation,
the most important principle is to do no further harm.
Ground, water, and air transportation can be safe and
effective in fulfilling this principle, and no one form
is intrinsically superior to the others (n FIGURE 13-3).
Local factors such as availability, geography, cost,
and weather are the main factors determining which
mode to use in a given circumstance. n BOX 13-1 lists
general questions to ask in determining appropriate
transportation mode.
Interhospital transfer of a critically injured patient
is potentially hazardous; therefore, it is optimal to
box 13-1 questions that can assist
in determining appropriate
transport mode
• Does the patient’s clinical condition require
minimization of time spent out of the hospital
environment during the transport?
• Does the patient require specific or time-sensitive
evaluation or treatment that is not available at the
referring facility?
• Is the patient located in an area that is inaccessible to
ground transport?
• What are the current and predicted weather situations
along the transport route?
• Is the weight of the patient (plus the weight of required
equipment and transport personnel) within allowable
ranges for air transport?
• For interhospital transports, is there a helipad and/or
airport near the referring hospital?
• Does the patient require critical care life support (e.g.,
monitoring personnel, specific medications, specific
equipment) during transport, which is not available
with ground transport options?
• Would use of local ground transport leave the local
area without adequate emergency medical services
coverage?
• If local ground transport is not an option, can the
needs of the patient (and the system) be met by an
available regional ground critical care transport service
(i.e., specialized surface transport systems operated by
hospitals and/or air medical programs)?
Reprinted with permission from Thomson DP, Thomas SH. Guidelines for
Air Medical Dispatch. Prehospital Emergency Care 2003; Apr–Jun;7(2):265–71.
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