• This document provides guidance on who should conduct transfers, what resources are available and the training needs of those who will conduct transfers.

This is a controlled document. If you are using a printed copy, check it against the guidelines site to ensure you are using the latest edition. Print copies must be destroyed after use.

Abbreviations

Time critical transfers of critically ill adults and children from Frimley Health to a (MTC) or other tertiary centre are manpower and resource intensive and represent an area of risk both to the individual patient and to other patients in the hospital who may be deprived of senior clinical input during a transfer.

The aim of this document is to provide guidance on who should conduct transfers, what resources are available and the training needs of those who will conduct transfers.

It is not possible to list all the pathologies that might require a time critical transfer but time critical patients are defined as patients who need to be transferred to a tertiary centre to allow for a life/limb saving intervention that cannot be provided at the referring centre and which cannot wait for retrieval or further stabilisation.

• SCAS/SECAMB ambulance with non-paramedic crew

• SCAS/SECAMB ambulance with paramedic crew

• SCAS/SECAMB ambulance and ED Nurse escort

• SCAS/SECAMB ambulance and ITU/anaesthetic team escort

• SCAS Adult Critical Care transfer services

  • https://www.rescue-acct.org/ This service doesn't offer time critical transfer services, and operates 1030-2300 7 days a week but may be able to assist with selected cases. Contact early in the patient journey by phone on 0300 303 4147

• SORT paediatric retrieval service

  • https://www.sort.nhs.uk/home.aspx This service offers retrieval for critically ill children with either medical or trauma problems who are receiving level 3 (ventilated) care, but the response time means that they are not available for genuinely time critical cases. This service operates 24 hours a day 7 days a week and should be contacted early in the patient journey for any critically ill child

023 8077 5502. Further guidelines on time critical paediatric transfer are available here https: https://www.sort.nhs.uk/Media/Guidelines/Time-critical-transfer-checklist.pdf

• In addition Air Ambulance Kent Surrey Sussex offer a time critical transfer service for selected adults and children. The geography and constraints of the FPH helipad mean that this will rarely be a suitable option but the guidance is attached (daylight only for FPH). Contact HEMS dispatch desk at the earliest opportunity on 0300 123 5811 or 0782 798 2152

All level 3 (ventilated) patients will be transferred by the ITU/anaesthetic team.

Children requiring level 3 support will be discussed with the SORT team during preparation for transfer and the team will be heavily guided by the advice and direction that they provide. Where SORT is unable to respond in a timely fashion, responsibility for undertaking time critical transfers will lie with the hospital ITU/anaesthetic team, with support from the paediatric and ED teams.

Patients with threatened airway compromise should have their airway assessed and a judgement made and recorded by a senior anaesthetist prior to transfer.

Level 2 patients requiring haemodynamic support (IABP or vasoactive infusions) will be transferred by a suitable member or members of the ITU/anaesthetic team.

Level 1 patients with chest drains or blood component transfusion running should have an ED nurse escort (ambulance service policy). They do not require ITU/anaesthetic transfer.

Most ED Doctors do not have transfer training and should not be involved in the transfer of patients to other healthcare facilities unless they have received additional training e.g. because they have dual ICM or PHEM training.

Most other patients will be suitable for a time critical transfer with a paramedic ambulance crew, this includes patients with solid organ injuries who are haemodynamically normal and stable. Patients who have undergone a resuscitative thoracotomy and have achieved ROSC represent a special case where the expertise to manage these cases is not consistently held in the hospital. These cases should be discussed with the appropriate pre-hospital critical care team in the first instance (TVAA/AAKSS), see appendix 1 for more details.

The responsibility for the patient lies with the Trauma or Resuscitation team leader and therefore in cases where there are several possible transfer options the ED Consultant in charge or on call should work with the other healthcare practitioners involved to find the optimum solution for the patient being transferred and the other patients in the hospital.

A training programme will need to be developed to support ED nurses who will undertake transfers. Initially this might be delivered by Frimley Health but could in the future be delivered as part of the regional level 2 Trauma Nursing training.

• Following successful resuscitative thoracotomy patients will need urgent transfer to cardiothoracic theatres at the relevant MTC (St George’s for Frimley Park and John Radcliffe for Wexham Park).

• These patients meet automatic acceptance criteria and urgency will require the transfer to be arranged and underway before contacting the MTC.

• Discussing with the MTC first will cause significant delay and will make the process more complicated.

• Two doctors will need to go with the patient. An anaesthetist/intensivist to manage the airway and sedation and an ED consultant or senior registrar, for management of the open chest/further cardiac arrest.

• Patients are likely to be relatively unstable when transferred but keeping them at a TU is unlikely to be of benefit if the source of haemorrhage is thoracic.

• If the source of haemorrhage is below the diaphragm the patient may need damage control surgery or IR at Wexham/Frimley.

Process

1. ROSC post resuscitative thoracotomy

2. Patient stabilised as much as possible

3. Time critical ambulance requested

4. ED consultant and anaesthetist/intensivist transfer the patient to the MTC

5. Another ED consultant (registrar overnight) to contact the JR or St George’s (ED TTL and cardiothoracic consultant on-call) and inform them of the patient’s imminent arrival.

This guideline has been registered with the Trust. However, clinical guidelines are guidelines only. The interpretation and application of clinical guidelines will remain the responsibility of the individual clinician. If in doubt, contact a senior colleague or expert. Caution is advised when using guidelines after the review date.

This guideline is for use in Frimley Health NHS Foundation Trust hospitals only. Any use outside this location will not be supported by the Trust and will be at the risk of the individual using it.

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