1 Outside Patient Transfers National Pediatric Nighttime Curriculum Written by Erin Augustine, MD Lucile Packard Children s Hospital at Stanford
2 Case 1 A 5 year old male is being transferred from an outside hospital with an asthma exacerbation. He will be a direct admit to your service. What specific pieces of information would you want to know from the transferring physician?
3 Case 2 A 3 year old female presents with trouble breathing. She is tachypneic, grunting, flaring, and retracting. Her work of breathing mildly improves with oxygen by face mask. Transport to nearest PICU 10 miles away is recommended. What type of transportation is indicated? Basic Life Support (BLS) Ambulance Advanced Life Support (ALS) Ambulance Critical Care Transport Air Transport
4 Objectives To understand obligations of the Emergency Medical Treatment and Active Labor Act (EMTALA). To identify key pieces of information that need to be communicated when a patient is being transferred to another facility. To compare various patient transportation options and choose the most appropriate option.
5 Objectives To understand obligations of the Emergency Medical Treatment and Active Labor Act (EMTALA). To identify key pieces of information that need to be communicated when a patient is being transferred to another facility. To compare various patient transportation options and choose the most appropriate option.
6 EMTALA Emergency Medical Treatment and Active Labor Act Enacted by Congress in 1986 Passed because of concerns that emergency departments were refusing to treat or inappropriately transferring patients based on ability to pay ( patient dumping )
7 EMTALA EMTALA Obligations Hospitals must provide a medical screening exam to determine if an emergency medical condition exists. If an emergency medical condition exists, the patient must be treated and stabilized. If a hospital does not have the capability to treat the condition, an appropriate transfer to another hospital should be made.
8 Objectives To understand obligations of the Emergency Medical Treatment and Active Labor Act (EMTALA). To identify key pieces of information that need to be communicated when a patient is being transferred to another facility. To compare various patient transportation options and choose the most appropriate option.
9 Communicate Patient Information Name, Age, Weight Medical Condition Pertinent Past Medical History & Medications Allergies Vital Signs (Including BP & O 2 Sat) Pertinent Physical Exam Findings Mental Status Airway Status Perfusion Assessment Interventions Performed & Response to Therapy Condition Updates Send Copies of Notes, Labs, Imaging Studies
10 Communicate Recommendations Providing Advice IS Recommended Management Airway Management Oxygen Intubation IV Placement Medication Administration Evaluation Labs Imaging Mode of Transportation
11 Objectives To understand obligations of the Emergency Medical Treatment and Active Labor Act (EMTALA). To identify key pieces of information that need to be communicated when a patient is being transferred to another facility. To compare various patient transportation options and choose the most appropriate option.
12 Transport Considerations Local Resources Staff Availability & Training Equipment Medications Distance of Transport Transport Availability Road Conditions & Weather
13 Transportation Options Basic Life Support (BLS) Advanced Life Support (ALS) Critical Care Neonatal Air Helicopter Fixed-Wing Airplane
14 Basic Life Support Transport Team EMT-Basic Capabilities Administer Oxygen Administer IV Fluids Immobilize Administer Limited Selection of Medications Albuterol, EpiPen, Oral Glucose Recommended if Stable Patient Immediate Transport Necessary ( Load & Go )
15 Advanced Life Support Transport Team EMT-Paramedic Capabilities Intubate Obtain IV Access Administer Oral & IV Medications Recommended if Life-Threatening Condition Altered Consciousness Respiratory Distress
16 Critical Care Transport Team EMT or Special Care Transport Paramedic Critical Care Transport Nurse(s) +/- Respiratory Therapist +/- Physician Capabilities Cardiac Monitoring Vasoactive Medication Administration Ventilatory Support
17 Air Transport Recommended if Long Distances Poor Road Conditions or Weather Weather May Restrict Helicopter Transport Too Patient Requires Immediate Intervention Hemorrhage
18 Air Transport Special Considerations Unable to pull over to work on patient Noise prohibits auscultation Pneumothorax Low pressure at high altitude may lead to pneumothorax expansion. Helicopter transport is acceptable because it flies at sea level. Fixed-wing airplane transport is only acceptable if the cabin is pressurized to sea level. Best to avoid high altitude for 6 weeks after pneumothorax resolution.
19 Take Home Points EMTALA ensures that patients with emergency medical conditions are treated regardless of ability to pay. Communication of specific patient details is essential for safe patient transfer. Knowledge of transportation options and capabilities optimizes safe patient transport.
20 References American College of Surgeons Committee on Trauma, American College of Emergency Physicians, National Association of EMS Physicians, Pediatric Equipment Guidelines Committee-Emergency Medical Services for Children (EMSC) Partnership for Children Stakeholder Group and American Academy of Pediatrics. Policy Statement Equipment for Ambulances. Pediatrics :e Baumann MH. Pneumothorax and Air Travel: Lessons Learned From a Bag of Chips. Chest : Orr RA, Felmet KA, Han Y, McCloskey KA, Dragotta MA, Bills DM, Kuch BA, Watson RS. Pediatric specialized transport teams are associated with improved outcomes. Pediatrics :40-8. Sirbaugh PE, Leswing V. Prehospital Pediatrics. UpToDate
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