Process of Transfer

Pre-transport communication and coordination:

• Telephone or videoconference the referrer, gather a history, conduct an 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 transfer ^{(11, 12)}. 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 the above.

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.

An example of a brief check on the patient is:

• Airway is secured and patent.
• Ventilation is adequate; respiratory variables are appropriate.
• All equipment alarms are switched on.
• The patient is haemodynamically stable.
• Vital signs are displayed on transport monitors and are clearly visible to transport staff.
• PEEP/CPAP (if set) and FiO2 levels are correct.
• All drains (urinary, wound or underwater seal) are functioning and secured.
• The underwater seal drain is not clamped.
• Venous access is adequate and patent.
• Blood products and IV fluids are available.
• IV drips and infusion pumps are functioning properly.
• The patient is safely secured on a trolley.
• The charge status of all electrical equipment has been checked.