Inter-hospital Transfer of the Critically Ill

One of the purposes of this textbook is to assist clinicians practicing in the emergency department with optimally caring for patients with critical illness or injury. Often, the severity of the patient can be too great for many hospitals to provide definitive care, and patients may require specialized therapeutic modalities and physicians with specialized training who are not available at all hospitals. Despite the outstanding care that can be delivered in the emergency department for critically ill patients, transfer to a referral center is required for definitive care. The process of transferring a critically ill or injured patient from a hospital into the back of a ground or air ambulance should only occur after careful planning and consideration of the risks and benefits of transfer. Much of the process is defined by legislative mandate of the Emergency Medical Treatment and Active Labor Act (EMTALA), and this chapter will explain the EMTALA-defined process. The determination of the appropriate timing of transfer and how much assessment and resuscitation should be provided prior to initiating transfer is a highly nuanced decision which this chapter will also help elucidate. Additionally, the medical crew accompanying the critically ill patient must be selected by the sending clinician so that the crew is capable of appropriately responding should the patient decompensate en route. This chapter will focus on the process of inter-hospital transfer of a critically ill patient and will help the sending clinician optimize the longitudinal treatment and safe transfer of the patient.