Advanced Trauma Life Support ATLS Student Course Manual 2018

TRANSFER PROTOCOLS 249
stabilize the patient’s condition before transport, ensure
transfer personnel are properly trained, and make
provisions for managing unexpected crises during
transport. To ensure safe transfers, trauma surgeons
must be involved in training, continuing education, and
quality improvement programs designed for transfer
personnel and procedures. Surgeons also should be
actively involved in developing and maintaining
systems of trauma care. See “Appropriate use of
Helicopter Emergency Medical Services for transport
of trauma patients: Guidelines from the Emergency
Medical System Subcommittee, Committee on Trauma,
American College of Surgeons.”
in transfer. The most acceptable IT (information
technology) enhanced communication medium may
be used to avoid delay in transfer.
Treatment during Transport
Trained personnel should transfer the patient, based
on the patient’s condition and potential problems.
Treatment during transport typically includes:
••
Monitoring vital signs and pulse oximetry
••
Continuing support of cardiorespiratory system
Transfer Protocols Pitfall prevention
When protocols for patient transfer do not exist, the
following guidelines regarding information from
the referring doctor, information to transferring personnel,
documentation, and treatment during transport
are suggested.
Information from Referring Doctor
The doctor who determines that patient transfer
is necessary should speak directly to the physician
accepting the patient at the receiving hospital. The
ABC-SBAR (refer to n TABLE 13-2) can serve as a checklist
for the telephone report between physicians and the
verbal report to transporting personnel.
Information to Transferring
Personnel
Information regarding the patient’s condition and
needs during transfer should be communicated to
the transporting personnel (refer to the ABC-SBAR
template in n TABLE 13-2).
Documentation
A written record of the problem, treatment given, and
patient status at the time of transfer, as well as certain
physical items (e.g., disks that contain radiologic
images), must accompany the patient (n FIGURE 13-4).
Digital media may be transmitted to the referring
facility to expedite the transfer of information and
make imaging available for review at a distance; when
electronic transmission is not possible, facsimile
transmission of reports may be used to avoid delay
Dislodged or malpositioned
endotracheal
tubes and intravenous
lines during transport
Failure to anticipate
deterioration in the
patient’s neurologic
condition or hemodynamic
status during
transport
• Ensure that necessary
equipment for reintubation
and line placement
accompanies the patient.
• Verify that transfer personnel
are capable of performing
the procedure and
managing any potential
complications that occur.
• Ensure tubes and lines are
adequately secured.
• For elderly patients,
intoxicated patients,
and patients with head
injuries, there is often
no way to predict if
neurological status will
change; thus, airway
protection during
transport is sometimes
indicated for individuals
with GCS scores >8.
• The transporting physician
should consider the
possibility of potential
neurological change and
airway compromise when
deciding to intubate
before transport.
• The receiving surgeon
should offer advice if
the decision to intubate
is not clear based on
consideration of the injury
pattern and transport
time.
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