NCEPOD: Trauma - Who Cares? - London Health Programmes

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CHAPTER 10 - TransfersKey findingsRecommendationsThere was a lack of adherence to the numerousrecommendations and guidelines that exist regarding thetransfer of critically ill and severely injured patients.The arrangements for the secondary transfer of severelyinjured patients were haphazard.One in four severely injured patients required asecondary transfer to receive defi nitive care.The use of a helicopter system reduced the need forsecondary transfers compared to a road ambulancesystem.The documentation of transfers was almost uniformlypoor.Despite the limited information available from thepoor documentation, there was an apparent lack ofconsultant input into the arrangement and conduct ofsecondary transfers.This study of a three month period suggests that thereare approximately 800 transfers annually for severetrauma and that the situation of ‘many critically illpatients are transferred between hospitals in an adhoc manner by inexperienced trainees with little formalsupervision and potentially serious complications canoccur’ is correct. There does not appear to have beenany signifi cant change in the last fi ve years.A clear record of the grade and specialty of allaccompanying staff involved in the transfer or retrievalof severely injured patients should be made and thisdocumentation should accompany the patient ontransfer. (Trauma team leader)There should be standardised transfer documentation ofthe patients’ details, injuries, results of investigations andmanagement with records kept at the dispatching andreceiving hospitals. (Trauma team leader, Department ofHealth)Published guidelines must be adhered to and auditsperformed of the transfers and protocols. (Hospitaltrusts)Local networks should develop protocols for thetransfer of severely injured patients suitable for regionalrequirements. (Hospital trusts)The number of transfers may be decreased ifappropriate arrangements are made for cross cover inspecialties, e.g. interventional radiology, between trusts.(Hospital trusts)124
10TransfersReferences1. Mackenzie PA, Smith EA, Wallace PG. Transfer of adultsbetween intensive care units in the United Kingdom:postal survey. BMJ. 1997 May 17; 314(7092):1455-62 Mendelow et al. Risks of intracranial haematoma in headInjured Adults. BMJ 1983; 287:11733. McMonagle MP et al. Anz J Surg 2007; 77: 241 – 24613. AAGBI Recommendations for the transfer of patientswith head injuries to neurosurgical injuries. 199614. Intensive Care Society. Guidelines for transport of thecritically ill adult. London: Intensive care Society 199715. Stevenson A et al. Emergency department organisationof critical care transfers in the UK. Emerg Med J. 2005Nov; 22(11):795-84. Deane SA et al. Anz J Surg 1990; 60: 441-4465. Strobos J. Ann Emerg Med 1991; 20: 302-3106. Clemmer TP Crit Care Med 2000; 28: 265-266)7. Intensive Care Society. Guidelines for transport of thecritically ill adult. London: Intensive Care Society 20028. Dunn LT. Secondary insults during the intra hospitaltransfer of head injured patients: an audit of transfers inthe Mersey Region. Injury 1997; 28:427-319. Gentleman D. Causes and effects of systemiccomplications among severely head-injured patientstransferred to a neurosurgery unit. Int Surg 1992;77:297-30210. Gentleman D et al. Audit of transfer of unconscious headinjured patients to a neurosurgical unit. Lancet 1990;335:330-411. Have ATLS and national transfer guidelines improvedthe quality of resuscitation and transfer of head-injuredpatients? Injury 2003 34:834-83812. Knowles PR et al. Meeting the standards for interhospitaltransfer of adults with severe head injury in the UnitedKingdom. Anaesthesia. 1999 Mar; 54(3):283-8125
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Trauma: Who cares?A report of the N
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ContentsAcknowledgements 4Foreword
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AcknowledgementsThis is the twenty
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AcknowledgementsThe organisations t
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ForewordSevere injury - a car crash
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Summary of fi ndingsThis study show
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Principal recommendationsOrganisati
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IntroductionTrauma remains the four
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IntroductionReferences1. Chaira 0,
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MethodQuestionnaires and casenotesT
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MethodQuality and confidentialityA
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CHAPTER 1 - Data overviewFigure 2.
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CHAPTER 1 - Data overviewMode of ar
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CHAPTER 2 - Organisational dataTabl
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CHAPTER 3 - Overall assessmentAll c
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CHAPTER 3 - Overall assessmentKey f
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CHAPTER 4 - Prehospital careRespons
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CHAPTER 4 - Prehospital careFigure
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CHAPTER 4 - Prehospital careTranspo
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CHAPTER 4 - Prehospital careAdequac
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CHAPTER 4 - Prehospital careIn 40/5
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CHAPTER 4 - Prehospital carecaused
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CHAPTER 5 - Hospital receptionIntro
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CHAPTER 5 - Hospital receptionTable
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CHAPTER 5 - Hospital receptionTraum
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CHAPTER 5 - Hospital receptionTable
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CHAPTER 5 - Hospital receptionThese
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CHAPTER 5 - Hospital receptionOvera
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CHAPTER 6 - Airway and breathingInt
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CHAPTER 7 - Management of circulati
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CHAPTER 7 - Management of circulati
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Page 114 and 115: CHAPTER 9 - Paediatric careOrganisa
Page 116 and 117: CHAPTER 9 - Paediatric careClinical
Page 118 and 119: CHAPTER 9 - Paediatric careKey find
Page 120 and 121: CHAPTER 10 - TransfersIntroductionM
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Page 128 and 129: CHAPTER 11 -Incidence of trauma and
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Page 136 and 137: APPENDIX B - Injury severity scoreA
Page 138 and 139: APPENDIX C - Adult and paediatric G
Page 140 and 141: APPENDIX D - An example of an excel
Page 142 and 143: APPENDIX E - Level 1 trauma careAs
Page 144 and 145: APPENDIX F - ParticipationTrustCase
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Page 152: Published November 2007 by the Nati
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