Referral and Transfer of Trauma Patients

Children with major trauma need to be stabilised appropriately and to get to the right Major Trauma Centre (MTC) quickly for definitive care. Too many phone calls can introduce unacceptable delays that may impact upon outcomes.

Non-MTCs should refer any patient who they feel is beyond their resources to manage. The Major Trauma Networks (MTN) have agreed an immediate transfer policy. The MTC default position is to accept all referrals. Please refer to the Y&H Paediatric Major Trauma Guidelines.

How to refer (time critical / Emergency Department (ED) to ED referrals)

• Ensure the patient is being prepared for transfer

In parallel:

• The most senior ED doctor available should make the referral and the most senior MTC Paediatric ED doctor should receive the referral.
• All referrals should be made via Embrace by calling 0114 305 8200 selecting Option 1 ‘Trauma’.
• Embrace will immediately arrange a conference call between the referring hospital clinician and the appropriate MTC clinician. If necessary, specific additional clinicians (including the Embrace clinician on-call) can be included in the call.
• The conference call allows referral and the provision of any necessary clinical advice regarding stabilisation and transfer.
• The role of Embrace is to facilitate referral but, in most cases, Embrace will not provide a time critical transfer, and this must be done via the relevant ambulance service.
• The referral should be made in a structured fashion (eg. ATMIST). Referrals to the Leeds MTC should also be accompanied by an online Patient Pass referral to ensure robust documentation of demographics, physiology, injuries and imaging reports.
• If there is high suspicion of cardiac or vascular injury, the Sheffield MTC clinician may ask to conference in the Leeds MTC clinician for a decision on whether to transfer direct to Leeds
• The call should conclude with a clear statement of what has been agreed including emphasis that Embrace will not (in the majority of cases) be doing the transfer.

Arranging transfer

Note that all networks have agreed a ‘send & call’ approach. This means that in time critical cases the referring hospital ED should arrange transfer prior to or in parallel with referral.

• The ED at the referring hospital call their local ambulance service and state “Emergency Interfacility Transfer for Child Major Trauma Victim.”

Yorkshire Ambulance Service: 0330 678 4159

East Midlands Ambulance Service: 0115 967 5097

• Almost all trauma transfer requests will require a CATEGORY 2 response.
• If, in the opinion of the senior clinician in charge, the patient requires a CATEGORY 1 response then they should request that “the incident is escalated to a team leader or a clinical manager to call back to review with the senior clinician.”
• The accepting emergency physician at the MTC makes any necessary referrals to MTC specialist teams as appropriate to alert them to the patient being transferred.
• Transfer does not require the identification of a specific bed at the MTC and bed management concerns must not delay transfer.
• Unnecessary imaging (ie. imaging that will not change immediate management priorities) should not be performed prior to transfer.

The process is summarised in this poster which can be displayed in staff areas of Emergency Departments