Prehospital, Retrieval & Transfer

Question 1

Pros and Cons of retrieval transport options:
- Road
- Fixed wing
- Rotary

Answer 1

ROAD-
- Door-to-door (no airports)
- Space for family
- Can pull over
- Better patient access
- Cheap

• X Slow

FIXED WING-
- Long distances (only option for >300km)
- Bad weather
- Pressurised (up to 1ATM)
- Heated
- Fastest travel
- Space for family

• X Slow to initiate, slow land-to-ED time
• X Poor access to site
• X Pressure: air space expansion/ PaO2

ROTARY
- Good access incl winch access
- Direct-to-door at hospitals
- Fast travel
- Max 200 - 300km

• X Cost
• X Space
• X Weather
• X unpressurised
• Slow to initiate

Question 2

Challenges of air transfer:

Answer 2

• Limited space/ access
• Noise
• Altitude:
  –> Air space expansion
  –> PaO2 drop
• Cold
• Turbulence
• Travel sickness

Question 3

Components of safe transfer:

Answer 3

Indication

Method
- Intra: FACEM/Reg/Nurse
- Inter: Fixed, Rotor, Road
- Timing, weather

Receiving service ready
- Accepted, handed over, documents compiled + sent

Transfer team ready
- Appropriately trained, briefed
- Other duties covered
- Return trip/ accomodation
- Food/ water

Patient Prep
- Consider tube + vent (ultimate control)
- IV access dual + patent
- NGT, IDC
- Monitoring, OF (if paral)
- Air space expansion: chest tubes, split plaster
- Pretreat: nausea, anxiety
- Warm coverings

Equipment & Drugs Prep
- Expected + extra
- Infusions pre-mixed
- Emergency
- Change ETT balloon to saline (recheck pressure throughout flight)
- Document ETT depth

Other
- Family notified

Question 4

Deciding whether to perform a procedure on scene, or delay to hospital:

Question 5

What distance can various retrieval transport modes cover?

Answer 5

Rotary 100 - 200km
Road for shorter
Fixed wing for longer