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Critical care in the emergency department: patient transfer
  1. M J G Dunn1,
  2. C L Gwinnutt2,
  3. A J Gray1
  1. 1The Royal Infirmary of Edinburgh, Edinburgh, UK
  2. 2Hope Hospital, Salford, UK
  1. Correspondence to:
 Dr A J Gray
 Emergency Department, The Royal Infirmary of Edinburgh, 51 Little France Crescent, Old Dalkeith Road, Edinburgh EH16 4SA, UK; alasdair.gray{at}

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The intrahospital and interhospital transfer of critically ill patients is an inevitable part of emergency department practice. Critically ill patients have a high risk of morbidity and mortality during transport. This article reviews current recommendations for the transfer of critically ill patients, with a particular focus on pre-transfer stabilisation, hazards during transport and the personnel, equipment and communications necessary throughout the transfer process.

Transfers can be primary or secondary. In the UK, primary transfers to hospital from a prehospital site of illness or injury are commonly the responsibility of the ambulance service. These systems may be supported or supplemented by doctors. Secondary transfers include both intrahospital and interhospital transport, and are inevitable for all critically ill patients in the emergency department unless they die during their time in the resuscitation room. Emergency departments may also receive interhospital critical care transfers as an intermediate destination.

The decision to transfer a patient to another hospital is made after an assessment of the potential risks and benefits to the patient. Indications for interhospital transfer include the need for specialist investigation or intervention, or ongoing support not provided in the referring hospital. Non-clinical reasons for transfer include the lack of an appropriately staffed critical care bed locally, or repatriation to a local hospital.1 Interhospital transfers are often made out of normal working hours, and the patient may be accompanied by relatively junior staff, leading to a high rate of critical incidents. These transfers account for up to 30% of all interhospital critical care transport, and half of these are patients with trauma.2 The need for standards and training in such transfers were emphasised >10 years ago.3 This has been dealt with to some extent by the Safe Transfer and Retrieval course, but many trainees still lack training in the transfer of …

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  • Funding: None.

  • Competing interests: None.