456 Administrative and Legal Issues
Retrieval and Inter-hospital Transfer
1 Retrieval is the transport of a sick or injured patient by specially trained staff
from a lesser-equipped (sending) hospital to a higher-level (receiving) hospi-
tal for further care.
2 The sending doctor should speak directly to the receiving hospital doctor or
retrieval specialist using a dedicated, single-point-contact coordinated
communication system.
3 The decision to transfer, the risks involved, the benefits expected and the
patient preparation are agreed on.
(i) The sending doctor commences usual required care, such as
two i.v. cannulae, nasogastric tube, indwelling catheter, fracture
splinting, and advanced airway/respiratory/cardiovascular
procedures, according to their ability.
4 A transfer letter, photocopy of notes and forms, lab results, X-rays, ECGs,
etc. are prepared for the retrieval team/receiving hospital.
5 Road transport is suitable for short distances, and helicopters for longer
ones. Light aircraft are used when helicopter flying time exceeds 90–120
minutes.
(i) Helicopters and small aircraft require expert crew and landing
areas, incur high costs, need dedicated equipment, and involve
flight physiology considerations such as altitude hypoxia and
trapped gas expansion (e.g. in a pneumothorax).
6 Retrieval equipment must be compact, portable, light, robust and reliable,
and have adequate battery capacity. Special ventilators, monitors, suction
equipment, alarms, defibrillator, mattress and an equipment frame ‘bridge’
are essential.
7 Retrieval staff will spend time assessing, stabilizing and packaging the
patient at the sending hospital, pre-empting any potential complications
prior to transfer. It is not a time to rush.
8 The aim is to improve the level of care at each stage, particularly during
high-risk times such as loading and unloading during the inter-hospital
travel.Major Incident
External disaster
1 A sudden inf lux of a large number of casualties is variously known as an
Externa l Disaster, Code Brown, Major Incident or Mass Casua lt y Disaster.