Advanced Trauma Life Support ATLS Student Course Manual 2018

BIBLIOGRAPHY 251
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Continued balanced fluid resuscitation
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Using medications as ordered by a doctor or as
allowed by written protocol
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Maintaining communication with a doctor or
institution during transfer
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Maintaining accurate records during transfer
When preparing for transport and while it is underway,
remember that during air transport, changes in
altitude lead to changes in air pressure. Because this
can increase the size of pneumothoraces and worsen
gastric distention, clinicians should carefully consider
placing a chest tube or gastric tube. Similar cautions
pertain to any air-filled device. For example, during
prolonged flights, it may be necessary to decrease the
pressure in air splints or endotracheal tube balloons.
When transporting pediatric patients, pay special
attention to equipment sizes and the expertise of
personnel before transport.
Transfer Data
The information accompanying the patient should
include both demographic and historical information
pertinent to the patient’s injury. Uniform transmission
of information is enhanced by the use of an established
transfer form, such as the example shown in Figure
13-4. In addition to the information already outlined,
provide space for recording data in an organized,
sequential fashion—vital signs, central nervous system
(CNS) function, and urinary output—during the initial
resuscitation and transport period.
TeamWORK
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When the level of care exceeds the capabilities
of the treating facility, the trauma team leader
must work quickly and efficiently to initiate
and complete transfer to definitive care.
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Other team members can assist the team leader
by communicating with the receiving facility
while the trauma team leader remains focused
on the patient.
••
The team leader ensures rapid preparation for
transfer by limiting tests (particularly CT scans)
to those needed to treat immediately lifethreatening
conditions that can be managed by
specialists and facilities at hand.
••
Upon accepting a patient for transfer to
definitive care, team members will collaborate
to prepare records for transfer, including
documentation of diagnoses, treatment,
medications given, and x-rays performed.
Chapter Summary
1. Patients whose injuries exceed an institution’s
capabilities for definitive care should be identified
early during assessment and resuscitation.
Individual capabilities of the treating doctor,
institutional capabilities, and guidelines for
transfer should be familiar. Transfer agreements
and protocols can expedite the process.
2. Life-threatening injuries should be identified
and treated to the extent possible at the referring
(local) facility. Procedures and tests that are
not required to stabilize the patient should not
be performed.
3. Clear communication between the referring and
receiving physician and transporting personnel
must occur. ABC-SBAR is a useful template
to ensure key information about the patient
is communicated.
4. Transfer personnel should be adequately skilled
to administer the required patient care en route
to ensure that the level of care the patient receives
does not decrease.
5. Special patient group considerations should be
made when deciding who to transfer. Pre-defined
transfer agreements can speed the process.
Bibliography
1. American College of Surgeons Committee
on Trauma. Resources for Optimal Care of the
Injured Patient. Chicago, IL: American College
of Surgeons; 2006.
2. Bledsoe BE, Wesley AK, Eckstein M, et
al. Helicopter scene transport of trauma
patients with nonlife-threatening injuries:
a meta-analysis. J Trauma 2006;60:
1257–1266.
3. Borst GM, Davies SW, Waibel BH et al. When
birds can’t fly: an analysis of interfacility
ground transport using advanced life support
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