Process of Transfer

Pre-transport communication and coordination

• Telephone or videoconference the referral, gather a history, conduct and exam, check vital signs and initiate investigations.
• Accept the transfer. Discuss the patient with referring and receiving senior medical staff and agree that transfer is feasible and beneficial and should proceed.
• Provide stabilisation advice and institute any additional management.
• Agree on the required medical and/or nursing attendants during transport.
• Decide the appropriate mode and timing of transportation. Factors to consider include
  • patient condition, age and size
  • urgency of transfer
  • medical interventions anticipated
  • personnel and other resource availability
  • time of day
  • weather and/or traffic conditions
  • geographical considerations.
• Make a decision regarding the required monitoring, equipment and medication.

Ensuring patient readiness for transfer

Final preparation of the patient should be made before the actual move, with conscious anticipation of clinical needs. Patients should be appropriately resuscitated and stabilised prior to transfer in order to reduce the physiological disturbance associated with movement and reduce the risk of deterioration during the transfer⁹. Examples include giving appropriate doses of muscle relaxants or sedatives, replacing near-empty inotropic and other intravenous (IV) solutions with fresh bags, and emptying drainage bags.
The patient will need to be “packaged” prior to retrieval.

The packaging procedure aims to:
·         Minimise clot disturbance and repeated blood loss by reducing patient movement, application of pelvic binder or limb splints and limiting repeated log rolls.
·         Minimise spinal movements.
·         Minimise cytokine release.
·         Maintain normothermia.
·         Prevent pressure induced skin injuries.
Vacuum mats will often be used to facilitate this. 

Haemostatic packaging is based on the concept of “First clot is best” with any further bleeding depleting coagulation factors and resulting in worse patient outcomes¹⁰.
The patient must be reassessed before transport begins, especially after being placed on monitoring equipment and the transport ventilator (if used). Transport preparations must not overshadow or neglect the patient’s fundamental care.

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