Anaesthetists Handbook - MEDICAL EDUCATION at University ...

Inter-hospital transfersInter-hospital transfers[Appraised by Dr Mark Mead, January 2010]The referring consultant has responsibility for transferring a patient.Referral should be on a consultant-to-consultant basis. If intensivecare is likely to be needed then the consultant intensivist should alsobe informed.Accompanying personnelIdentifying an anaesthetist to go with the patient can be difficult (seealso page 30), if no critical care doctor is available to go. Liaise withthe general consultant on call, who may need to make plans forreduction in available resident staff.All front-line ambulances are equipped for ventilation. If you aretaking skilled staff with you, you may not need a paramedic crew.Discuss your needs with the senior nurse and the ambulance control.ProtocolAn agreed protocol covering all aspects of patient transfer (includinga separate head injury transfer protocol) is in place, and is found onthe critical care unit and in the emergency department. Essentialpoints are given below.Patients should not be transferred until they are physiologically stableand full monitoring is in place. Monitoring should always be of thestandard required for monitoring a patient on the ICU (provided thereare no contraindications) and therefore includes ECG, SpO 2, invasivearterial blood pressure, expired CO 2, urinary catheter and gastricdecompression tube. Please note that capnography is available andshould be used. CVP, temperature probe and pulmonary arterycatheter may be necessary. Management of specific conditions priorto transfer should be agreed with the receiving unit and all relevantinvestigations should be completed such as arterial blood gases,biochemistry, haematology, appropriate radiology and moreextensive investigations such as CT, MRI or peritoneal lavage ifindicated.Anaesthetists Handbook January 2010 59