Patient Preparation

 Airway

Ensure patient airway safety

  • Assess airway stability for all patients.
  • Secure the endotracheal tube (ETT). Ensure the tapes are firm and intact. If there is a suspected head injury, the tapes should not occlude venous drainage, preventing increases in intracranial pressure (tapes may need to be tied above the ears and secured with tape).
  • Record the length and diameter. Ensure a chest x-ray has been performed at the current ETT length.
  • Insert the orogastric tube. Ensure it is not secured to the ETT (so it is independently secure) and aspirate prior to transport.
  • It is preferable to replace hard (extrication) cervical collars with a Philadelphia collar to minimise the risk of a pressure injury. A cervical collar must remain in situ during transfer to a MTS, regardless of spinal clearance.

 Breathing

Ensure optimised oxygenation

  • Observe the patient’s respiratory rate and its character.
  • Measure the oxygen saturation (SpO2) and end-tidal carbon dioxide (ETCO2).
  • Administer oxygen using the correct delivery device.
  • Check arterial blood gases. If a head injury is suspected, ensure the partial pressure of carbon dioxide (PaCO2) is between 35 and 40 mmHg. This will optimise cerebral perfusion.
  • Secure an intercostal catheter (ICC) if present. Ensure the dressing is dry and intact and drainage system is functioning and not clamped/kinked.
  • Ventilation considerations:
    • If a head injury is suspected and the patient is receiving positive pressure ventilation, maintain PEEP levels below 10 cm of water to minimise the impact of increased intrathoracic pressures on intracranial pressure.
    • If there are known or suspected chest injuries ensure the tidal volume is 4–6 mL/kg to prevent an acute lung injury (13).
    • Avoid high peak inspiratory pressures.
    • If a flail segment is involved, consider early ventilation and utilise PEEP levels higher than usual.

 Circulation

Ensure IV access and management

  • Insert a minimum of two large-bore peripheral IV lines.
  • Secure all lines, ensuring the injection ports are accessible.
  • Attach a rapid infuser pump line and fluid for transfer.
  • Record all IV fluids. Ensure accurate documentation of all blood products administered.
  • Monitor vital signs for evidence of developing haemorrhagic shock.
  • Utilise serial blood gases to monitor Hb and lactate and consider serial coagulation screens to identify coagulopathy and guide blood product administration.
  • Transduce/monitor all arterial and central venous lines. Ensure lines are anchored appropriately and transducers are aligned with the phlebostatic axis.


 
Ensuring patient readiness
 
 
 

 Documentation

Ensure complete patient documentation

  • Provide copies of all medical and nursing clinical notes and charts.
  • Include all investigation results – pathology and ECG. Check the coagulation status and platelet count for all trauma patients.
  • Provide digital copies of all imaging – films, scans, MRI.
  • Advise of any ‘limitations of treatment’ orders.
  • Include the contact details of next of kin.
  • Include contact numbers for staff at the referral centre.
  • Ensure patient belonging/valuables are documented and included with the transfer.

 Alert

It is important that you notify the ARV coordinator of significant deterioration in:

  • Conscious state.
  • Blood pressure.
  • Heart rate.
  • Respiratory status.
  • Oxygenation.
  • Major clinical developments such as significantly abnormal diagnostic tests or new clinical signs.
  • The need for major interventions prior to the retrieval team arriving (6, 11, 12) (for example, intubation and surgery).
 

Other

Maintain body temperature

  • Hypothermia contributes to poor outcomes for trauma patients. Warm the patient to achieve normothermia and package to prevent heat loss (14).

Insert an in-dwelling catheter

  • Be mindful of potential bladder injuries – maintain a strict fluid balance chart.

Empty drainage bags prior to transport

  • Ensure clear documentation of fluid loss.

Administer antiemetic

  • Ensure clear documentation.

Maintain spinal precautions if indicated

  • In a major head injury, ensure the bed is tilted to 20–30 degrees to reduce intracranial pressure.

Stabilise or splint fractures

  • Pelvic injuries should be stabilised with a pelvic binder or bed sheet. If an unstable pelvic fracture is suspected, treat it with strict spinal precautions and do not log roll; use a Jordan frame or spinal board for transfers.
  • If limb immobilisation devices are applied, ensure there are no areas of potential pressure injury.

Check lab results and modify treatment if needed

Check all limbs for potential compartment syndrome

  • Maintain neurovascular observations, elevate the affected limb, and consider fasciotomy if circulation is compromised.

Ensure all open wounds are cleaned and covered

  • Be mindful that trauma patients are highly susceptible to infection and severe sepsis.
  • Impaled objects should not be removed but stabilised for transport to ensure no further movement or manipulation of the object is likely during transit.

Ensure adequate analgesia is in progress prior to transport

Notify the patient’s family or next of kin of the trauma transfer and ensure all patient property is identified and secured.

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