ARV can facilitate a multi-party conversation for advice on patient management with an array of specialist services. This should be considered early in the course of patient care, particularly for patients with:
Flail chest injury;
Multiple rib fractures;
Significant pulmonary contusion;
Any critical or life-threatening thoracic injury.
It is important to note that an exhaustive clinical workup or interventions are not always necessary or appropriate prior to transfer. Stabilisation and ensuring life-threatening problems are addressed, as well as taking measures to prevent deterioration, 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 partnership 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, care will be formally transferred to them after a thorough handover is provided. Retrieval staff will assess the patient prior to transfer and may make changes to care plans that ensure the patient is safe during transfer. The use of a transfer checklist can assist in ensuring that important information is not overlooked or omitted.
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, 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. This facilitates preparation of the angiography suite at the receiving MTS, as well as allowing consultation with the receiving team regarding blood pressure control.
Pericardial fluid or tamponade With prior knowledge that a patient with suspected pericardial tamponade is being transferred, 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.