Transport, Transfer and Stabilization burn patient (Health care provider perspective)

1. Transport, Transfer and Stabilization burn patient (Health care provider perspective) M. Hayek TEACHING ASSESTANCE/RN Medical complex, nursing college Najah national university 2011

2. Introduction This paper describe the procedure in the event of transferring burn patient from field to hospital or burn center or from department to another need one

3. Likely indication Level of intensive care\ special therapies not provide by the previous department Burn healed but not continued requirement for intensive care Bed not available Moving a patient nearer home

4. Procedure (pediatric) These patient are mostly likely to be those requiring advance pediatric intensive care and as such the majority of these children will be retrieved by the PICU retrieval team example children acute transport services. If clinical urgency are availability of the retrived team indicates that transfer should not be delayed follow the adult procedure.

5. Transfer (adult) patient The patient should be stabilized prior to transfer. The airway should be secured prior to transport. The patient should have adequate venous access and their circulatory status should be stabilize Appropriate measure should be taken to maintain temp. Patient who are conscious, their relative, should be kept fully informed

6. Procedure (staff) Appropriately trained and experience nursing and medical personal are required for all intensive care patient requiring transfer. The final decision in the most appropriate personal at the time of transfer rest with the consultant anesthetist and nurse in charge of the shift

7. Medical Anesthetist SpR or above, with appropriate skill and training in transfer usually resident SpR for burns, if out of the hours consultant must be present in the hospital to cover the unit and will not be free for other duties If the anesthetic consult is required for the transfer then they must ensure that suitable cover is arranged

8. Nursing • The nurse in charge of the shift will designate the most appropriate nurse to assist with transfer. This will depend on the clinical status of the patient. • This may require the on call senior nurse to attend the unit to provide cover.

9. Equipment and Monitoring • Staff must all be familiar with the equipment they will be using. Minimum standard of monitoring Ecg,Spo2,Fio2,BP(usually invasive),Temp ,If Ventilated and it setting,O2 and airway, transfer monitor, oxygen supplies, resusestation drugs, sedation drugs and fluids. • The transfer pack should be checked before departure. • For all transfers a self inflating bags is mandatory.

10. Communication Staff should ideally have access to a mobile phone to allow contact with the unit and money for emergences \ transport It should be agreed with the ambulance services if staff and equipment will be returned to base, and if not appropriate alternative arranged before department

11. Documentation Written and verbal hand over between staff should be carried out on arrival. An observation chart should be complete during the transfer with any intervention\ untoward incidents document. Copies of relevant notes, X-rays and investigation should accompany the patient All transfer will be audited.

12. Safety Patient and staff is paramount at all times Patient should be adequately harnessed for their safety and all equipment including syringe pump, monitor and ventilator fixed down. All staff should wear seat belts and remain seated at all time.

13. considerationTransport Appropriate facility. Burn center or not. Factor to take in consideration. Burn patient severity criteria. Critical. Moderate, minor burn criteria. Confounding criteria. Transport facilities.

15. Note If any emergency intervention are indicated the vehicle should be stopped. The attached checklist published by the intensive care society are helpful.

16. Followed Note No “Goo” on burn unless directed by burn center Health care provider including physions and nurses must be as team with the other same team in the other center and must be working in collaboration should make the decision as to the mode of transportation and the required stabilization measures.

17. Note Communication and teamworkare crucial to an effective transport and optimal patient outcome

18. Thanxxxxx For attention