Interhospital transfer of the trauma patient

Despite the considerable interest in trauma care which has developed over the past 10 years, little attention has been given to interhospital transfer. Yet a third of major trauma cases admitted to neurosurgical centres have been transferred from other hospitals, often after considerable delay and with deficiencies in diagnosis or management. Following major trauma, head injury remains the commonest indication for transfer by far. Safe transport should allow medical treatment to be continued without detrimental effects to the patient. Physiological stabilization is of paramount importance, including vigorous avoidance of hypotension after major head injury, but unnecessary delay must also be avoided. The transfer process can be considered in four phases with good communication an essential component throughout. An experienced transfer or retrieval team is required, together with robust portable equipment and a set of versatile drugs. Further tools to aid transfer include golden rules and a handover template. Current developments include specific training programmes for safe transfer and the setting and implementation of standards of care.