Introduction
Retrieval generally involves transferring patients with critical illness or life-threatening injury – situations where the patient requires the highest levels of clinical care and vigilance. Transfers are required when the needs of the patient exceed the resources of the hospital.2 Retrieved patients are often unstable, at the margin of physiological compensation, and in need of specialised investigation and intervention. They are often at that phase of an emergency presentation where diagnosis is incomplete, treatment is problem-focused and risk is high. This setting therefore requires special expertise, risk-averse processes and fail-safe systems characterised by anticipation, redundancy, rapid response and reliability. If executed poorly, the transfer of critically ill patients is potentially hazardous. It is important to focus on pretransfer stabilisation, the anticipation and management of hazards and the selection of the correct personnel and equipment3.
Coordination
Retrieval is a coordinated process that provides specialised assessment and management, prior to and during transfer of critically ill patients from situations where resources or services are inadequate to a destination where definitive care can be provided.
Movement ‘up the chain of care’
The approach aims to deliver the same or higher level of clinical care than that available at the point of referral, ensuring the patient is not exposed to any reduction in the quality of clinical care despite the inherent risks of the transport environment.
Need for retrieval systems
The need for retrieval is related to the limitations of health facilities, the geography of populations as well as the patient’s injuries4. Rural communities have a right to equitable and timely access to critical care medicine; however, it is recognised that there is often an urban–rural divide in regard to the accessibility of healthcare generally and to specialised critical care in particular. Key clinical ‘gap’ areas exist at both urban and rural and regional levels regarding trauma, neurosurgery, cardiac, neonatal and paediatric critical care. Advances in medicine and technology are unavoidably concentrated in major metropolitan centres, increasing the need for critical patient transport (such as coronary percutaneous procedures and interventional radiology such as angio-embolisation) to an MTS, and paediatric tertiary and quaternary care hospitals. Given that such divides exist and that critical care transfer is inevitable, retrieval medicine aims to ensure quality of care in transfer in distinction to the somewhat ad hoc approach to irregular critical care transfers that otherwise may be the case in less systemised approaches.
The retrieval of injured patients from a referring health facility has the primary objective of improving patient outcomes through the coordinated support and timely transfer of major trauma patients by highly capable transfer teams, to an appropriate trauma service.