Adult Retrieval Victoria (ARV), can facilitate a three way conversation for advice on patient management with a specialist from a major trauma service. This should be considered early in the course of patient care, particularly for patients with:
Multiple rib fractures.
Significant pulmonary contusion.
Large pneumothorax, or
Any critical or life-threatening thoracic injury.
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.
The use of a transfer checklist can help to ensure that important information is not omitted and the patient is packaged accordingly. In specific reference to major thoracic trauma, it is important that the following information is relayed to the receiving hospital as soon as possible, even prior to patient transfer, so as to facilitate timely intervention on their arrival at the MTS:
Suspicion or confirmation of blunt aortic injury:
It is vital that CT imaging be made available to the treating MTS as soon as practical. If possible, images should be shared via the ‘Hub and Spoke’ system. This facilitates preparation of the angiography suite at the receiving MTS, as well as allowing consultation with the receiving team regarding blood pressure control en route.
Pericardial fluid or tamponade:
With prior knowledge that a patient with suspected pericardial tamponade is en route, preparations can be made for a cardiac theatre and relevant personnel to be available upon the patient’s arrival. Survival in these patients is dependent on time to operative intervention.
Massive haemothorax with ongoing bleeding:
As with pericardial tamponade, the survival of patients with intrathoracic bleeding that requires operative intervention is dependent upon time to theatre.