Hostname: page-component-848d4c4894-tn8tq Total loading time: 0 Render date: 2024-07-08T05:04:12.252Z Has data issue: false hasContentIssue false
  • English
  • Français

Adverse Events during Interfacility Transfers by Ground Advanced Life Support Services

Published online by Cambridge University Press:  28 June 2012

Richard Wuerz  and
Steve Meador
Richard Wuerz*
Affiliation:
Division of Emergency Medicine, The Milton S. Hershey Medical Center, Pennsylvania State University
Steve Meador
Affiliation:
Division of Emergency Medicine, The Milton S. Hershey Medical Center, Pennsylvania State University
*
Emergency Medicine, College of Medicine, the Milton S. Hershey Medical Center, P.O. Box 850, Hershey, PA 17033USA
Get access Rights & Permissions [Opens in a new window]

Abstract

Objective:

To identify risk factors for adverse events that occur during interfacility transfers by advanced life support (ALS).

Design:

A four-year, retrospective, case series.

Setting:

Three ALS units in a rural/suburban emergency medical services (EMS) system.

Participants:

351 transports to or from twelve acute care facilities; two patients records could not be located.

Interventions:

Patients were classified by illness/injury, transporting staff, and ongoing therapy; these were correlated with frequency of ALS intervention and patient deterioration.

Results:

During the study period, the number of transfers as a percentage of total calls (1.1%–5.2%) rose consistently. There were 11 illness/injury categories; the largest was cardiac (44%, 154 patients). Hospital staff accompanied the patient in 15% (52). Advanced life support (ALS) therapy was required in 4.9% (17): one monitored cardiac arrest was defibrillated successfully, 13 patients required unanticipated medication therapy, and three were noted to have clinical deterioration en route. The upper 95% confidence limit for cardiac arrest is 12.9/1,000 transfers or 20.8/1,000 hours. Patient deterioration and the need for ALS intervention were associated with the presence of medication infusions (p <.O5), but not with hospital staff (p >.40).

Conclusions:

Interfacility transfers of a heterogeneous group of patients in this series involve a low risk of cardiac arrest. Patients with medication infusions are at higher risk of deterioration and more frequently require ALS intervention en route. The presence of hospital staff had no measurable effect. These findings have implications for the development of ALS transfer protocols.

Keywords

advanced life supportemergency medical servicesinterfacility transfers
Type
Original Research
Information
Prehospital and Disaster Medicine , Volume 9 , Issue 1 , March 1994 , pp. 50 - 53
Copyright
Copyright © World Association for Disaster and Emergency Medicine 1994

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1. Sternbach, G, Sumchai, AP: Is aeromedical transport of patients during acute myocardial infarction safe? Am J Emerg Med 1989;7:73–77.CrossRefGoogle ScholarPubMed
2. Hackel, A, Simon, JE, Wingert, WA, Bergeson, PS: Guidelines for air and ground transportation of pediatric patients. Pediatrics 1986;78:943–950.Google Scholar
3. Schwab, CW, Peclet, M, Zackowski, SW et al. : The impact of an air ambulance system on an established trauma center. J Trauma 1985;25:580–586.CrossRefGoogle Scholar
4. American college of emergency physicians: Guidelines for transfer of patients. Ann Emerg Med 1985;14:1221–1222.CrossRefGoogle Scholar
5. Frew, S: Patient Transfers: How to Comply with the Law. Dallas: American College of Emergency Physicians, 1991.Google Scholar
6. Waddell, G, Scott, PDR, Lees, NW, Ledingham, IM: Effects of ambulance transport in critically ill patients. Br Med J 1975;1:386–389.CrossRefGoogle ScholarPubMed
7. Olson, CM, Jastremski, MS, Vilogi, JP et al. : Stabilization of patients prior to interhospital transfer. Am J Emerg Med 1987:5:33–39.CrossRefGoogle ScholarPubMed
8. Strobos, J: Tightening the screw: Statutory and legal supervision of interhospital patient transfers. Ann Emerg Med 1991:20:302–310.CrossRefGoogle ScholarPubMed
9. Kerr, HD, Byrd, JC: Community hospital transfers to a VA medical center. JAMA 1989;262:70–73.CrossRefGoogle ScholarPubMed
10. Shanaberger, CJ: Understanding COBRA's twists and turns. JEMS 1991;101–103.Google Scholar
11. Lazar, RA: The venom of COBRA: Does it reach the skies? MedicAir 1991;18–19,25–26.Google Scholar