Advanced Trauma Life Support ATLS Student Course Manual 2018
BIBLIOGRAPHY 251 •• Continued balanced fluid resuscitation •• Using medications as ordered by a doctor or as allowed by written protocol •• Maintaining communication with a doctor or institution during transfer •• 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 •• 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. •• 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 n BACK TO TABLE OF CONTENTS
252 CHAPTER 13 n Transfer to Definitive Care when helicopter emergency medical service is unavailable. J Trauma 77(2):331–336. 4. Brown JB, Stassen NA, Bankey PE et al. Helicopters improve survival in seriously injured patients requiring interfacility transfer for definitive care. J Trauma 70(2):310–314. 5. Champion HR, Sacco WJ, Copes WS, et al. A revision of the trauma score. J Trauma 1989; 29:623–629. 6. Compton J, Copeland K, Flanders S, et al. Implementing SBAR across a large multihospital health system. Joint Commission J Quality and Patient Safety 2012;38:261–268. 7. Doucet J, Bulger E, Sanddal N, et al.; endorsed by the National Association of EMS Physicians (NAEMSP). 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. J Trauma 2013 Oct 75(4):734–741. 8. Edwards C, Woodard, E. SBAR for maternal transports: going the extra mile. Nursing for Women’s Health 2009;12:516–520. 9. Harrington DT, Connolly M, Biffl WL, et al. Transfer times to definitive care facilities are too long: a consequence of an immature trauma system. Ann Surg 241(6):961–968. 10. McCrum ML, McKee J, Lai M, et al. ATLS adherence in the transfer of rural trauma patients to a level I facility. Injury 44(9):1241–1245. 11. Mullins PJ, Veum-Stone J, Helfand M, et al. Outcome of hospitalized injured patients after institution of a trauma system in an urban area. JAMA 1994;271:1919–1924. 12. Onzuka J, Worster A, McCreadie B. Is computerized tomography of trauma patients associated with a transfer delay to a regional trauma centre? CJEM:10(3):205–208. 13. Quick JA, Bartels AN, Coughenour JP, et al. Trauma transfers and definitive imaging: patient benefit but at what cost? Am Surg 79(3):301–304. 14. Scarpio RJ, Wesson DE. Splenic trauma. In: Eichelberger MR, ed. Pediatric Trauma: Prevention, Acute Care, Rehabilitation. St. Louis, MO: Mosby Yearbook 1993; 456–463. 15. Schoettker P, D’Amours S, Nocera N, et al. Reduction of time to definitive care in trauma patients: effectiveness of a new checklist system. Injury 2003;34:187–190. 16. Sharar SR, Luna GK, Rice CL, et al. Air transport following surgical stabilization: an extension of regionalized trauma care. J Trauma 1988;28:794–798. 17. Thomson DP, Thomas SH. Guidelines for Air Medical Dispatch. Prehospital Emergency Care 2003; Apr–Jun;7(2):265–71. n BACK TO TABLE OF CONTENTS
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- Page 310 and 311: Appendix A OCULAR TRAUMA OBJECTIVES
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252<br />
CHAPTER 13 n Transfer to Definitive Care<br />
when helicopter emergency medical service is<br />
unavailable. J <strong>Trauma</strong> 77(2):331–336.<br />
4. Brown JB, Stassen NA, Bankey PE et al. Helicopters<br />
improve survival in seriously injured patients<br />
requiring interfacility transfer for definitive care.<br />
J <strong>Trauma</strong> 70(2):310–314.<br />
5. Champion HR, Sacco WJ, Copes WS, et al. A<br />
revision of the trauma score. J <strong>Trauma</strong> 1989;<br />
29:623–629.<br />
6. Compton J, Copeland K, Flanders S, et al.<br />
Implementing SBAR across a large multihospital<br />
health system. Joint Commission J Quality and<br />
Patient Safety 2012;38:261–268.<br />
7. Doucet J, Bulger E, Sanddal N, et al.; endorsed<br />
by the National Association of EMS Physicians<br />
(NAEMSP). Appropriate use of helicopter<br />
emergency medical services for transport of<br />
trauma patients: guidelines from the Emergency<br />
Medical System Subcommittee, Committee on<br />
<strong>Trauma</strong>, American College of Surgeons. J <strong>Trauma</strong><br />
2013 Oct 75(4):734–741.<br />
8. Edwards C, Woodard, E. SBAR for maternal<br />
transports: going the extra mile. Nursing for<br />
Women’s Health 2009;12:516–520.<br />
9. Harrington DT, Connolly M, Biffl WL, et al.<br />
Transfer times to definitive care facilities are<br />
too long: a consequence of an immature trauma<br />
system. Ann Surg 241(6):961–968.<br />
10. McCrum ML, McKee J, Lai M, et al. <strong>ATLS</strong> adherence<br />
in the transfer of rural trauma patients to a level<br />
I facility. Injury 44(9):1241–1245.<br />
11. Mullins PJ, Veum-Stone J, Helfand M, et al.<br />
Outcome of hospitalized injured patients after<br />
institution of a trauma system in an urban area.<br />
JAMA 1994;271:1919–1924.<br />
12. Onzuka J, Worster A, McCreadie B. Is computerized<br />
tomography of trauma patients associated<br />
with a transfer delay to a regional trauma<br />
centre? CJEM:10(3):205–208.<br />
13. Quick JA, Bartels AN, Coughenour JP, et al.<br />
<strong>Trauma</strong> transfers and definitive imaging: patient<br />
benefit but at what cost? Am Surg 79(3):301–304.<br />
14. Scarpio RJ, Wesson DE. Splenic trauma. In:<br />
Eichelberger MR, ed. Pediatric <strong>Trauma</strong>: Prevention,<br />
Acute Care, Rehabilitation. St. Louis, MO: Mosby<br />
Yearbook 1993; 456–463.<br />
15. Schoettker P, D’Amours S, Nocera N, et al.<br />
Reduction of time to definitive care in trauma<br />
patients: effectiveness of a new checklist system.<br />
Injury 2003;34:187–190.<br />
16. Sharar SR, Luna GK, Rice CL, et al. Air transport<br />
following surgical stabilization: an extension<br />
of regionalized trauma care. J <strong>Trauma</strong><br />
1988;28:794–798.<br />
17. Thomson DP, Thomas SH. Guidelines for Air<br />
Medical Dispatch. Prehospital Emergency Care<br />
2003; Apr–Jun;7(2):265–71.<br />
n BACK TO TABLE OF CONTENTS