EVAKUASI

Initial Assessment and Management

If definitive care cannot be provided at
a local hospital, the patient requires
transfer to a hospital that has the
resources and capabilities to care for
him or her.
 Case Scenario
A 27-year-old male is brought to an 80-bed
rural hospital following an MVC.
The hospital has a CT scanner and ultrasound
capability, but no neurosurgical capability.
Vital signs: Systolic BP 80; shallow
breathing; and GCS score 6.

What are your concerns and priorities in

organizing transfer of this patient?
 Objectives

1. Identify injured patients who require transfer to

a higher level of care.
2. Discuss optimal preparation for safe patient
transfer.
kal

Transfer Principles

Know institutional capabilities

Be prepared and anticipate patient needs.
Do no further harm.
Identify patients whose needs exceed local
resources
 Transfer Principles

Perform only essential procedures.

Establish direct communication between
referring and receiving doctors.
Transport to closest, appropriate facility.
Use most appropriate mode of transport.
 Transfer Decisions

Whom do I transport?
 Transfer Decisions
Whom do I transport?
Patients with multiple injuries
Patients whose needs exceed institutional
capabilities
Patients with comorbidities
Extremes of age
Preexisting disease
 Transfer Decisions

Where should I send the patient?

 Transfer Decisions
Where should I send the patient?
Transfer to an institution capable of providing
equipment and resources
Transfer to an appropriate, qualified physician
who can:
Make the diagnosis
Treat the patients injuries
Provide commitment and resources
 Transfer Decisions
When should I transport the patient?
 Transfer Decisions
When should I transport the patient?
Transfer after life-threatening problems are
managed.
Transfer after disabling injuries are stabilized.
Transfer after arrangements are made.
Transfer before performing unnecessary tests
and procedures.
Avoid delay!
 Transfer Decisions

How should I transport the patient?

 Transfer Decisions
How should I transport the patient?
Determine by:
Care required en route
Patient destination
Available resources
Existing transfer
agreements
 Case Scenario
A 27-year-old male is brought to an 80-bed
rural hospital following an MVC.
The hospital has a CT scanner and ultrasound
capability, but no neurosurgical facility.
Vital signs: Systolic BP 80; shallow
breathing; and GCS score 6.

What are your concerns and priorities in

organizing transfer of this patient?
 Summary

Patients with injuries exceeding an institutions

capabilities should be transferred.

Provide optimal preparation for safe transfer.