Transfer and retrieval response will be managed according to patient need following clinical consultation with ARV, the MTS and the referring facility. The following presentations should be consulted for early transfer to a MTS:
All penetrating abdominal injuries.
Fractured or suspected fractured pelvis.
Haemodynamic instability (BP<90).
Abdominal distention or guarding.
Abdominal trauma with significant distracting injury.
Positive FAST or DPL.
Free air under the diaphragm.
Significant gastrointestinal hemorrhage.
In a resource-limited setting, suspected intra-abdominal trauma patients who are haemodynamically stable and without obvious peritoneal signs should be discussed with ARV and the MTS. The decision to transfer will be based upon a number of factors to include available investigations, the patients’ comorbidities and distance from the closest hospital to provide definitive care should the patient’s condition deteriorate. It is important to note that an exhaustive clinical workup and interventions is not always necessary or appropriate prior to transfer. Stabilisation and ensuring life-threatening problems are addressed, as well as taking measures to prevent deterioration en route, are essential aspects of early care. Delaying transfer to obtain laboratory results or imaging studies may simply delay access to definitive treatment. Often such studies must be repeated at the receiving facility. In liaison with ARV clinicians, interventions to stabilise the patient prior to retrieval personnel arriving should be commenced. ARV will coordinate the retrieval and will evaluate the practicality and clinical needs involved in transferring the patient from the source hospital. Once retrieval staff arrives on scene, be prepared to give a thorough handover. Retrieval staff will assess the patient prior to transfer and may make changes to care in order to ensure the patient is safe during transfer. Patients who do not present with any indications of intra-abdominal injury requiring CT evaluation and have no other distracting injuries requiring closer inspection may be observed with serial abdominal examinations and discharged if no reason for admission is found.