EM · ED systems, safety and professional

Retrieval and inter-hospital transfer

Also known as Inter-hospital transfer · Secondary retrieval · Aeromedical retrieval · Patient transport · Drip-and-ship · Time-critical transfer · Specialist retrieval

Retrieval and inter-hospital transfer is the structured process of moving a patient between facilities (or from scene to facility) to deliver a level or type of care the referring site cannot provide. The decision rests on three transfer types — time-critical (STEMI door-to-balloon, stroke thrombolysis and thrombectomy windows), specialist (trauma, burns, neurosurgery, paediatric, neonatal, ECMO), and repatriation — each with its own urgency, mode, and team. Pre-transfer packaging converts an unsafe move into a safe one: secure the airway (RSI before transfer for the patient with GCS 8 or less), secure the lines (two large-bore IVs, an arterial line, central access for the unstable), secure the monitors (ECG, SpO2, NIBP, capnography), secure the ventilation (mechanical ventilator with set parameters), and secure the sedation (morphine 2.5 mg with midazolam 2.5 mg, titrated). Mode — road, fixed-wing, or rotary — is chosen on distance, physiology, weather, and the time-versus-stability trade-off. Team composition (physician-staffed versus paramedic/nurse) is matched to the predicted deterioration risk. The governing differential is the decision itself: stay-and-play (resuscitate to stability first) versus scoop-and-run (load and go, manage on the move), with the time-critical bypass (direct to PCI, to thrombolysis, to a trauma centre) as the third path. Transport-related deterioration — hypoxia, hypotension, hypothermia, gas expansion at altitude, line and tube loss, undetected desaturation — is the central risk, and the discipline is to minimise it by preparation, not improvisation. ACEM-primary, globally tagged.