FRCA Notes

Transfer Medicine

The transfer medicine section of the curricula is relatively chunky.

Instead of re-hashing the rather in-depth guidelines, my notes instead focus on a few key areas that cropped up in practice questions or seemed of higher yield.

Resources

  • Requirement for specialist interventions e.g. neurosurgery, cardiothoracic surgery
  • Requirement for specialist organ support e.g. availability of RRT
  • Repatriation close to home
  • Lack of local critical care bed availability i.e. 'non - clinical transfer'

  • In general, don't transfer until patient has been resuscitated and stabilised as this reduces:
    • The disturbance to patient physiology associated with movement
    • The risk of deterioration during the transfer
  • A 'scoop and run' philosophy is only appropriate when the urgency of the situation and need for definitive treatment will limit time available for stabilisation e.g. leaking AAA

  • A pre-transfer risk assessment should take place, and checklists should be used, to minimise the risks of transfer

Minimum monitoring for transfer

  1. A secure airway, if necessary

  2. Saturations monitoring
    • End-tidal CO2 in the ventilated patient
    • Establish on transport ventilator prior to being moved

  3. Appropriate venous access
    • Continuous 3-lead ECG monitoring
    • Continuous invasive BP monitoring
      • NIBP may rapidly deplete battery power, and is unreliable when there is external movement/vibration due to motion artefact
      • Other invasive cardiac monitoring e.g. PA catheter is impractical during transfer

  4. Continuous observation of the patient

  5. Temperature monitoring
    • Consider NG tube
    • Consider urinary catheter

  • Factors influencing decision regarding mode of transport include:
Transport-related Patient factors Organisational factors
Availability of modes of transport Urgency of transfer Staff & availability
Distance & geography from location to destination Contraindications to air travel e.g. pneumothorax Cost
Weather

Ambulance

  • Use of blue lights is ultimately at the discretion of the ambulance driver
  • Their use is indicated by:
    • Urgency of transfer e.g. patient condition
    • Degree of congestion/traffic

  • Transfer trolley is fitted with restraints to aid staff safety:
    • Patient restraints i.e. multi-point harness
    • Equipment restraints e.g. on ventilator, oxygen and pumps

Helicopter

Issue Potential consequence
Reduced atmospheric pressure Expansion of gas in closed cavity e.g. tension pneumothorax
Turbulence Nausea, vomiting or aspiration
Temperature/humidity changes Hypothermia, hyperthermia and dehydration
Noise Impairs communication
Missed alarms
Ear damage
Vibration and motion artefact Imapirs monitoring (NIBP, Sats)