Page 231 - 2026 SMOG

POST-OPERATIVE AND CC INTERFACILITY TRANSFER
Clinical Indications
• Patient at outlying MTF requiring transfer to higher role of care for more definitive surgery/
treatment
PRE-TRANSFER Patient Status Requirements
• JTS CPG—Intra-theater Transfer and Transport—recommends clinical parameters that should
be met prior to transfer; if parameters are not met, they should be addressed and enroute
mitigation plans formulated BEFORE departure/transfer:
˚ Heart Rate 50–120bpm
˚ SBP >90mmHg (MAP >60mmHg)
˚ SpO >9096%,1 FiO required <50%
2
2
˚ Temp >95ºF/35ºC
˚ Urine Output >50mL/h
˚ Hemoglobin >8.0g/dL
˚ Platelets >50k/mm³
˚ INR <2.0
˚ Base Deficit <6
˚
Lactate <2.5 mmol/L
If these criteria are not met, the transferring physician should continue resuscitation or provide
documentation indicating limitations that compel urgent transfer. Do NOT transport if the patient
has the following:
HR <50 or >120, systolic BP <90, core temperature <35°C, SpO <90% on supplemental O , Hct
2
2
<21, base deficit below 5°, or pH <7.3. The patient may be transported IF documentation indicates
the need for transfer prior to restoration of physiology to more normal parameters.
• Attempt to keep patient packaging time at <25min; use of warming devices in accordance with
the JTS Hypothermia Prevention CPG.
• Movement of Deceased Patients:
˚ In general, patients who meet clinical criteria for death are not to be transported by
MEDEVAC, with the exception of extreme extenuating circumstances, such as emergency
exfiltration during CSAR.
˚ If vital signs are absent prior to launch, make all reasonable attempts to resuscitate as clinical
and tactical circumstances permit. If unsuccessful, consider basic cardiac ultrasound (as
available) to determine whether any signs of cardiac activity are present. If absent, mission
abort is warranted.
˚ In such circumstances, contact and consultation with medical control or other available
physicians are suggested in order to facilitate field determination of death and cessation of
resuscitative efforts.
Procedure
• Role 2/3 provider responsibilities:
It is the responsibility of the transferring physician to write en route care orders appropriate for
the transport environment and individualized for each patient in consultation with the Critical
Care Flight Paramedic and/or the ECCN (or attending Flight Provider) prior to launch. The
Flight Paramedic/Provider should be given a Standard Order Set for Critical Care Transfers or a
similar document with en route care orders signed by the transferring physician.
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2026 Standard Medical Operating Guidelines (SMOG) • 223