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● Centralisation of specialist
Transfer services
● Increasing demand
The Numbers
● An assumption that these skills must be present for the clinician to function
day to day
Types of
Types of Guidelines
Guidelines & Speciality
Specialty
Transfer
Risks
Risks Organisation
Organisation
and Training
Training considerations
Considerations
Transfer
Types of
Types of Guidelines
Guidelines & Speciality
Specialty
Transfer
Risks
Risks Organisation
Organisation
and Training
Training considerations
Considerations
Transfer
Types of Transfer
1. Primary
○ Land ambulance
○ Typically “Scene to Emergency Department”
2. Secondary
○ Intra/Inter-hospital transfer
○ Example: ICU admission from ward
○ Example: Transfer to CUH for Neurosurgical input
Categories of Interhospital Transfer
CATEGORY 1 CATEGORY 2
Specialist support or Organ support that is
investigation not available locally
CATEGORY 3 CATEGORY 4
Repatriation Local lack of critical
care beds
Types of
Types of Guidelines
Guidelines & Speciality
Specialty
Transfer
Risks
Risks Organisation
Organisation
and Training
Training considerations
Considerations
Transfer
1. Physiological
3. Legal
1. Physiological - Dynamic
● Effect of Acceleration on the body
● Newton’s Third Law
○ EXTERNAL FORCE: The transfer vehicle’s
acceleration
○ INERTIAL FORCE: The body’s reaction
● Inertial force occurs in x-axis, y-axis and
z-axis
○ X-axis: Antero-posterior
○ Y-axis: Lateral
○ Z-axis: Cephalo-caudal
○ Or any combination of the above
● Effects
○ Cardiovascular
○ Gastrointestinal
1. Physiological - Static
● Noise
● Vibration
● Temperature
● Atmospheric Pressure
2. Transfer Safety
● Assessment
● Control
Organisation ● Communication
● Evaluation
● Transport
Assessment
● Lines of responsibility
Control and Communication
● Priority 1
○ Immeadite, time critical life saving intervention
○ < 8 minutes
● Priority 2
○ Life- or limb-saving intervention
○ < 1 hour
● Priority 3
○ Clinical reason for transfer, but not Priority 1 or 2
○ < 4 hours
● Priority 4
○ Non clinical
● Initial resuscitation
○ ABCD approach
● Acknowledge Murphy’s Law
● Checklist
Training ● Training
○ STAR course
○ Dip Transfer and Retrieval
Medicine RCSEd
Types of
Types of Guidelines
Guidelines & Speciality
Specialty
Transfer
Risks
Risks Organisation
Organisation
and Training
Training considerations
Considerations
Transfer
Speciality ● Neurosurgical Transfer
Types of
Types of Guidelines
Guidelines & Speciality
Specialty
Transfer
Risks
Risks Organisation
Organisation
and Training
Training considerations
Considerations
Transfer
Resources
● AAGBI Guidelines
○ Interhospital transfer 2009
○ Safe transfer of patients with brain injury 2006
● ICS Guidelines 2011
● Transfer of the critically ill adult
○ Hunt, D - Surgery 2015
○ Macartney and Nightingale - BJA 2001
● Secondary transfer of the critically ill adult
○ Handyman, J - Current anaesthesia and critical care 2007
Thank you