For centres that do not carry the majority of reversal medication or have access to a blood bank, the best option is to initiate retrieval and transfer early.
It is important to note that an exhaustive clinical workup and intervention 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 delay access to definitive treatment. Often such studies must be repeated at the receiving facility regardless.
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 practical and clinical needs involved in transferring the patient from the referral hospital. Once retrieval staff arrive 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.
In consultation with ARV and the MTS, if bleeding is critical and supply is not available at the facility, transport of antidotes / procoagulants can be arranged and brought to site with retrieval staff.