10 trauma patient transfers

  • 1,183 views
Uploaded on

 

  • Full Name Full Name Comment goes here.
    Are you sure you want to
    Your message goes here
  • Hello, I discovered your very interesting presentations in the Slideshare group 'HEALT AND MEDICINE' (http://www.slideshare.net/group/healt-and-medicine ). I take this opportunity to referencer some of your presentations. Thank for sharing. Greetings from France. Good day. Kate
    NB: I write an identical message on each présentation
    PS: I also added you Slidecast to our others group :
    - BANK OF KNOWLEDGE - http://www.slideshare.net/group/bank-of-knowledge
    Are you sure you want to
    Your message goes here
    Be the first to like this
No Downloads

Views

Total Views
1,183
On Slideshare
0
From Embeds
0
Number of Embeds
0

Actions

Shares
Downloads
33
Comments
1
Likes
0

Embeds 0

No embeds

Report content

Flagged as inappropriate Flag as inappropriate
Flag as inappropriate

Select your reason for flagging this presentation as inappropriate.

Cancel
    No notes for slide

Transcript

  • 1. Trauma Patient Transfers What, When, How? Charles F. Rinker, II MD, FACS
  • 2. ACSCOT
    • Does not dictate whom to transfer
    • …but local statutes might
    • Publishes guidelines regarding clinical conditions that might warrant transfer
    • Expects trauma program to review outcomes, adjust accordingly
  • 3. Basic Principles
    • When in doubt…transfer
    • Do what is best for the patient
    • Be realistic about your ability to treat
      • Personal capabilities
      • Institutional capabilities
    • Understand EMTALA
    • Know state statutes/trauma system regulations
    • Transfers go upstream, not down
  • 4. Be Prepared
    • Trauma program with GS leadership
    • Involvement with EMS
    • Trauma team, activation criteria
      • Scene transport
      • Bypass
    • Collegial relationship with regional trauma center/participation in trauma system
    • Transfer agreements
    • Performance review
  • 5. Define Your Trauma Patient
    • Surgical, medical specialties
    • Imaging equipment
    • Operating room(s)
    • ICU
    • Ancillary services
    • Proximity to other trauma centers
    • Interhospital transfer capabilities
  • 6. EMTALA
    • Emergency Medical Treatment and Active Labor Act
    • Intended as “anti-dumping” legislation
    • Effectively a federal guarantee for access to emergency care
    • Draconian penalties
    • Law of unintended consequences
  • 7. Compliance with EMTALA
    • Early evaluation, Rx in ED
    • Identify, document need for transfer
    • Consult with receiving hospital, and assist in transfer arrangements
    • Stabilize to degree possible before transfer
    • Best defense: ability to demonstrate actions are in best interest of patient (i.e., pt needs exceed resources)
    • Potential loss of Medicare approval
  • 8. Penalties
    • Failure to properly evaluate emergency medical condition
    • Inappropriate transfer
      • Medical condition not stabilized
      • Service could have been provided at transferring institution
      • Failure to receive approval from receiving institution
    • Refusal to accept patient, despite apparent need for transfer
  • 9. Treatment Options
    • Stabilization and transfer to definitive care
    • Operative stabilization and transfer
    • Local definitive care
  • 10. WHAT to Transfer?
    • Patients at the extremes of age
    • Major burns
    • Multisystem trauma
    • Serious comorbidities
    • Patient or family request (if feasible)
    • Any condition or constellation of injuries that exceeds local resources (personnel, equipment, back-up)
  • 11. WHEN to Transfer?
    • As soon as
      • Need is identified
      • Consultation with receiving hospital accomplished
      • Transport arrangements completed
      • Patient is properly stabilized (remember EMTALA)
    • Avoid unnecessary tests, procedures, “wallet biopsies”
  • 12. HOW to Transfer?
    • Surface v. air: depends on
      • Available resources
      • Patient condition/needs
    • Accompanied by
      • Appropriate personnel
      • Records, test results, images
      • Medications, blood, supportive equipment
    • To higher level of care, preferably within a trauma system
  • 13. HOW to Transfer?
    • Transfers should not be viewed as loss of surgical manhood
    • Goal: efficiency and appropriateness
    • Resuscitate and arrange for transfer simultaneously rather than sequentially.
      • Dispatch of transport vehicle is principal rate-limiting step
  • 14. Stabilization
    • Proceed according to ATLS guidelines
      • Controlled airway
      • Satisfactory ventilatory status with/without support
      • Hemodynamically normal
      • Neurologic status normal or improving
      • At or approaching normothermia
      • Fractures splinted, wounds dressed, other indicated interventions completed
    • Now safe to transfer, if needed
  • 15. Unstable Patients
    • Must control airway, breathing before transfer
    • Hemodynamics
      • Transient or non-responders: identify and control, if possible, source of hemorrhage (thoracotomy, laparotomy, wound exploration, ex-fixators, etc.)
    • Intracranial mass lesion: consult with NS
      • Ventilatory, pharmacologic maneuvers
      • Burr holes
    • Hypothermia: various warming methods
  • 16. Summary
    • Identify the need for transfer early
    • Proceed efficiently
    • Know your limitations
    • Know the law
    • Do all within your power to stabilize prior to transfer
    • Act in the best interest of the patient
  • 17. ?