Contents
1. What does critical care transfer means ?
A critical care transfer refers to the movement of any critically ill patient either within a hospital ( intra-hospital transfer ) or to another hospital (inter-hospital transfer ) so that patient can receive definative care from a specialist team .
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| Sudhanshu Manwal Ot Technician |
2. Aim of critical care transfer
The aim of critical care transfer is to provide continuous and effective critical care support to the patient , despite of environment change .
3. Categories of transfer
1. Primary Transfer
MOVEMENT OF PATIENT FROM INCIDENT SITE TO THE NEAREST / IMMEDIATE RECEIVING HOSPITAL
like from playground to nearest hospital
2. Secondary Transfer
MOVEMENT OF PATIENT BETWEEN TWO HOSPITALS
like from small hospital to big hospital of that district or state .
3. Tertiary Transfer
TRANSFER OF PATIENT FROM SECONDARY HOSPITAL TO NATIONAL HOSPITAL CENTER
like from big state gov hospital to special central gov hospitals ( AIIMS OR PGIMER )
4. Quaternary Transfer
INTERNATIONAL TRANSFER
like from Indian hospital to American Hospital .
4. Preparation for transfer
In this post i am going to use ABCDE approach .
which stands for :
A - Airway
B - Breathing
C - Circulation
D - Disability
E - Everything Else
1. AIRWAY ( with cervical spine immobilization if indicated )
1. Patient who are at the risk of airway compromise should be intubated prior to transfer .
2. E.T. Tube should be well secured , size , length , grade of laryngoscopy at intubation should be recorded .
3. x ray or osculation and capnography should be done to confirm right et tube position .
4. Tracheostomy tube well secured , size , length should be recorded .
5. Face mask and airway Adjuncts
6. AMBU Bag : Artificial Manual Breathing Unit should be checked .
7. Bain circuit should be checked .
8. Appropriate range of airway equipment should be available
2. BREATHING
1. Record baseline oxygen requirement , minute ventilation and O2 saturation .
2. checking of portable ventilator or bain circuit .
3. if ventilator is used set the current parameters
4. ensure ventilation is adequate and patient is stable on the portable ventilator for approx 10 minutes prior to departure .
5. check arterial blood gas prior to transfer
6. check ability to continue ventilation during any event like ventilator failure
a. AMBU BAG
b. BAIN CIRCUIT
7. stethoscope
8. adequate supplies of oxygen ( check o2 cylinder )
9. all the monitoring devices should be fully charged .
3. Circulation
1. examine cardiovascular system and record baseline
2. adequate i.v. access : there should be minimum two i.v. cannula .
3. adequate Hb concentration .
4. is patient haemodynamically stable
5. ECG and IBP with nibp monitoring as backup .
6. drugs
ANY VASOPRESSOR
SUFFICIENT QUANTITY AVAILABLE
ADDITIONAL EMERGENCY DRUGS , ADRENALINE .
FLUIDS CRYSTALLOIDS
4. Disability
1. baseline GCS
2. if transferring a spinal injury patient , ensure there is doctor of current neurology to allow monitoring of changes through out route .
3. adequate sedation for transfer allowing for delays
4. check blood glucose
5. Everything Else
1. Nasogastric tube - reduce risk of regurgitation , decompress stomach ( important on aeromedical transfer )
2. folley catheterization
3.Investigation : send all the reports and investigation to the receiving hospital .
4. equipment check : batteries should be charged , equipment should be portable and certified for transportation , appropriate alarm limit should be set prior to transfer .
5. Minimum monitoring set of ECG , BP , SPO2 and Etco2 should be maintained throughout the transfer .
6. Environmental : patient warming & temperature monitoring
7. pressure area care : changes in position may be requires for longer duration of transfer .
8. patient and equipment should be secured
9. others things to remember for Inter Hospital transfer
telephone no of receiving unit and departure call .
communication of delays and complication during transportation .
appropriate clothing and footwear .
mobile phone and money .
plan for returning team to base .
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