TRANSFER TO DEFINITIVE

CARE
A T L S 1 0 TH E D I T I O N
 INTRODUCTION

• The Advanced Trauma Life Support® course is

designed to train clinicians to be proficient in
assessing, stabilizing, and preparing trauma
patients for definitive care.
• Definitive trauma care, whether support and
monitoring in an intensive care unit (ICU),
admission to an unmonitored unit, or operative
intervention, requires the presence and active
involvement of a team of providers with the
skills and knowledge to manage the injuries
sustained by the trauma patient.
Determining the need for patient transfer:
TRANSFER FACTORS

• Patients who require prompt transfer can

be identified on the basis of physiologic
measurements, specific identifiable
injuries, and mechanism of injury.
• Patients with severe head injury (GCS
score of 8 or less) and hypotension are
easily recognized and warrant urgent
transfer.
Determining the need for patient transfer:
TRANSFER FACTORS (CONT…)

• To assist clinicians in determining which

patients require care at a higher-level facility,
the ACS Committee on Trauma recommends
using certain physiological indices, injury
mechanisms and patterns, and historical
information.
• Suggested guidelines for interhospital transfer
when a patient’s needs exceed available
resources are outlined in table below.
 Determining the need for patient transfer:
TIMELINESS OF TRANSFER
• Patient outcome is directly related to the time
elapsed between injury and properly delivered
definitive care.
• Consequently, trauma teams should develop
effective communication with the prehospital
system to identify patients who require a doctor to
be present in the ED at the time of arrival.
• In addition, the attending doctor must be
committed to respond to the ED before the arrival of
critically injured patients.
Determining the need for patient transfer:
TIMELINESS OF TRANSFER (CONT…)
• If resources are available and the necessary
• procedures can be performed expeditiously, life-
threatening injuries should be treated before patient
transport. This treatment may require operative
intervention to ensure that the patient is in the best
possible condition for transfer.
• Do not perform diagnostic procedures (e.g.,
diagnostic peritoneal lavage [DPL] or CT scan) that
do not change the plan of care.
Treatment before transfer:
AIRWAY
Treatment before transfer:
BREATHING
Treatment before transfer:
CIRCULATION
 Treatment before transfer:
CENTRAL NERVOUS SYSTEM
 Treatment before transfer:
PERFORM APPROPRIATE DIAGNOSTIC
STUDIES
 Treatment before transfer:
WOUNDS AND FRACTURE
 MODES OF TRANSPORTATION

• When choosing the mode of patient

transportation, the most important principle is to
do no further harm.
• Ground, water, and air transportation can be
safe and e ective in fulfilling this principle, and
no one form is intrinsically superior to the others
• Local factors such as availability, geography,
cost, and weather are the main factors
determining which mode to use in a given
circumstance.
 TRANSFER PROTOCOL

• When protocols for patient transfer do not exist, the

following guidelines regarding information from the
referring doctor, information to transferring personnel,
documentation, and treatment during transport are
suggested.
• Information from referring doctor
• The doctor who determines that patient transfer is necessary
should speak directly to the physician accepting the patient at
the receiving hospital. The ABC-SBAR (can serve as a checklist
for the telephone report between physicians and the verbal
report to transporting personnel.
• Information to transferring personnel
• Information regarding the patient’s condition and needs
during transfer should be communicated to the transporting
personnel (refer to the ABC-SBAR)
 TRANSFER PROTOCOL (CONT…)

• Documentation
• A written record of the problem, treatment given, and patient
status at the time of transfer, as well as certain physical items
(e.g., disks that contain radiologic images), must accompany
the patient.
• Treatment during transport
• Treatment during transport typically includes:
• Monitoring vital signs and pulse oximetry
• Continuing support of cardiorespiratory system
• Continued balanced fluid resuscitation
• Using medications as ordered by a doctor or as allowed by written
protocol
• Maintaining communication with a doctor or institution during
transfer
• Maintaining accurate records during transfer