Transfer

to

Definitive

Care

Case Scenario

● A 27-year-old male is brought to an 80-bed

rural hospital following an MVC.

● The hospital has a CT scanner and

ultrasound capability, but no neurosurgical

facility.

● Vitals: Systolic BP 80; shallow breathing;

and GCS score 6.

What are your concerns and priorities in

organizing transfer of this patient?

Objectives

● Identify injured patients who may

require transfer from the primary

facility to a trauma center.

● Discuss the procedures for optimal,

safe patient transfer.

Transfer Principles

● Know institutional capabilities.

● Be prepared and anticipate patient needs.

● Do no further harm.

● Identify patients whose needs exceed

local resources.

Transfer Principles

● Perform only essential procedures.

● Establish direct communication between

referring and receiving doctors.

● Transport to closest, appropriate facility.

● Use most appropriate mode of transport.

Transfer Decisions

● Patients with multiple

injuries

● Patients whose needs

exceed institutional

capabilities ● Patients with comorbidities

● Extremes of age ● Preexisting disease

Whom do I transport?

Transfer Decisions

● Transfer to an institution capable of

providing equipment and resources

● Transfer to an appropriate, qualified

physician who can: ● Make the diagnosis ● Treat the patient’s injuries ● Provide commitment and resources

Where should I send the patient?

Transfer Decisions

● Transfer after life-threatening problems are managed.

● Transfer after disabling injuries are stabilized. ● Transfer after arrangements are made. ● Transfer before performing unnecessary tests

and procedures.

When should I transport the patient?

Avoid delay!

Transfer Decisions

Determine by: ● Care required en route ● Patient destination ● Available resources ● Existing transfer

agreements

How should I transport the patient?

10

Pertanyaan

©ACS 11

Summary What is the problem?

Not all hospitals can care for all trauma

patients.

Who needs transfer?

Patient whose needs exceed local

resources.

Where should the patient be sent?

Ideally, to a verified trauma center.

©ACS 12

Summary

When should they be transported ?

After immediate, life-threatening injuries

are addressed.

How should the patient be transported

?

According to patient need and available

resources

©ACS 13

Kasus 1 (Lanjutan)

C. Menantu sang dokter 35 tahun dengan

kesakitan, keluar 7 menit kemudian,

merasa nyeri di dada kanan. Setelah

diperiksa paramedis, ada jejas di anterior

linea mid axillaris kiri setentang lipatan

payudara. TD 130/90 mmHg, Nadi

96x/menit, Nafas dangkal 36x/menit

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Kasus 1 (Lanjutan)

D. Istri sang dokter 63 tahun dikeluarkan tim

penolong 30 menit kemudian bersama

sang cucu dari danau yang dingin. TD

tidak terukur, Nadi tidak teraba, Nafas

tidak terdengar

E. Cucu sang dokter 7 tahun yang

dikeluarkan tim penolong danau, TD tidak

terukur, Nadi tidak teraba, Nafas tidak

terdengar

15