Page 252 - 2023 SMOG Digital

POST-OPERATIVE & 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:
a. 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
en-route mitigation plans formulated BEFORE departure/transfer:
1) Heart rate 50><120 bpm
2) SBP >90mmHg, MAP >60mmHg
3) If elevated ICP or CPP, maintain MAP 80><110mmHg, SBP 110><160mmHg
4) Hematocrit >24% (or Hgb >8g/dL)
5) Platelet count >50/mm 3
6) INR <2.0
7) pH >7.3
8) Base deficit <5mEq/L
9) Temperature >35.5⁰C or 96⁰F
10) EtCO2 35><45, SpO2 >92%, and/or PaCO2 35><45mmHg
If these criteria are not met, the transferring physician should continue resuscitation or
provide documentation indicating limitations that compel urgent transfer. This can be
documented in the comments section of the Standard Order Set for Critical Care
Transfers document.
b. The four MINIMUM requirements which will be met prior to patient transfer are
hemorrhage control, adequate shock resuscitation (SBP 90mmHg, MAP >60mmHg, UOP
>0.5mL/kg/hr, and/or BD <2, Temp >97⁰F and <100⁰F), stabilization of fractures, and
initial post-operative recovery.
c. Attempt to keep patient packaging time at <25 minutes; use of warming devices in
accordance with the JTS Hypothermia Prevention CPG.
d. Movement of Deceased Patients:
1) 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.
2) 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.

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