6. EARLY AND APPROPRIATE REFERRAL
Early referral O&G specialist
- DISTRICT MO BUDDY SPECIALIST
- HEALTH CENTRES without MO -->
SPECIALIST
Occasionally simultaneous referral to other
specialties may be necessary
(eg:anaesthetist/ physician/ surgeon)
7. RISK OF TRANSFERRING?
The decission to transfer patient in remote
parts may be decided on the risk involved in
transferring (eg:night transfer)
O&G specialist may decide against
transferring the patient or delay the transfer
till the next day if the risk of transfer is higher
than managing the case in the referring
centre
13. The following needs to be considered when
deciding on the best mode of transportation
a) Urgency of transfer
b) Condition of the patient
c) Availability of ambulance/ other mode of
transport
d) Distance and estimated transit time
e) Time of day & weather
f) MEDEVAC is an option but enquire first if it
can respond quickly enough
14.
15. 1.LAND TRANSPORTATION
Distance to Hospital Sibu about 45 minutes
to 1 hour
Condition of road
16. 2. AIR TRANSPORTATION
MEDEVAC
- Decision should be discussed with O&G
specialist JKNS
- Considerations include:
1. Severity of the cases
2. Availability of the helicopter
3. Weather
17.
18. KK BINTANGOR
(25 MINS)
KK RUSA
(30 MINS)
KK BALAI
(40 MINS)
KK BAYONG
(45 MINS)
KK MAONG
(5 HOURS)
KK ENSIRING
(5 HOURS)
KK ENTABAI
(3 HOURS)
KK SEKALUNG
(2 HOURS)
KK JULAU
(1 HOUR)
KK LASSI
(45 MINS)
KK ENTAIH
(2 HOURS 30
MINS)
KK PAKAN
(45 MINS)
KK KARA
(2 HOURS)
KK WAK
(1 H 15 MINS)
20. Ensure the ambulance or transport have the
required resuscitative equipments that is in
good working order (availability of oxygen
tank)
Ensure the staff escorting the patient knows
how to operate the resuscitative equipments
21. Ensure the appropriate medications
(eg:MgSO4, parenteral anti-HPT, sedatives,
muscle relaxants) which are needed should
be prepared in prefilled syringes
Crossmatch blood products to bring along if
indicated
22. If the patient is intubated ensure the Oxylog
is functioning or adequate oxygen tanks to
ensure the oxygen supply is adequate
NG tube is inserted to avoid aspiration during
transfer
24. Ensure that the relevant personnel are
alerted early (eg:ambulance driver, escorting
MO/SN, blood bank staffs)
In fact, obstetric drills may include scenario
involving patient transfer
All escorting staff should have at least
accreditation in BLS and ideally passed
SALSO
They must be able to recognise and address
any deterioration
They must be familiar with drugs and
equipment involved during transfer
26. This should be done systematically
throughout all levels
- Escorting MO Referral centre MO/
Specialist
- Escorting SN/ MA Referral centre SN
Proper communication & documentation is
vital
27. Sibu Hospital Retrieval Team
- Aim: to retrieve ill cases from clinics or
district and bring them back to the specialist
hospital
- The specialist/ consultant would make the
decission if the retrieval team should be
activated and depends on case to case basis
28. BENEFITS
- O&G team can perform surgery in district
hospitals before taking patient’s back to the
specialist hospital
- Team can optimise patient during transfer
- Team can manage complications better during
transfer
- Additional blood products
- Anaesthetic doctor could come along in the
relevant cases
DISADVANTAGES
- Longer time taken to transfer patient
29. CHECKLIST BEFORE DEPARTURES
1. INTUBATED PATIENT
- Oxylog functioning
- Adequate O2 supply
- ETT anchored
- Suction machine
- Nasogastric tube
- Oropharyngeal airways
- High flow mask/
ambubag
- Drugs-Muscle relaxant
and sedation
