ATLS Transfer to Definitive Care 2 — Questions and Answers
Question 1: What is the primary responsibility of the referring physician when transferring a trauma patient?
- Obtaining insurance authorization
- Initiating resuscitation and stabilization before and during transfer (Correct answer)
- Performing all definitive procedures
- Waiting for receiving facility to arrange transport
Correct answer: Initiating resuscitation and stabilization before and during transfer
The referring physician must assess, resuscitate, and stabilize the patient to the best of the facility's capability.
Responsibilities include direct physician-to-physician communication, documentation, ensuring appropriate monitoring during transport, and sending all records and imaging with the patient.
Question 2: During interfacility transfer, which monitoring is essential?
- Visual observation only
- Continuous pulse oximetry, cardiac monitoring, and blood pressure (Correct answer)
- Only hourly vital sign checks
- Monitoring only if intubated
Correct answer: Continuous pulse oximetry, cardiac monitoring, and blood pressure
Continuous monitoring is essential during transfer when intervention capability is limited.
Also capnography for intubated patients, urine output monitoring, and GCS documentation for head-injured patients. Transport team must be capable of managing anticipated complications.
Question 3: Which patient should be transferred to a Level I trauma center?
- Isolated forearm fracture
- GCS 10, hemodynamically unstable, positive FAST (Correct answer)
- Simple laceration
- Stable ankle sprain
Correct answer: GCS 10, hemodynamically unstable, positive FAST
This patient requires comprehensive surgical capabilities, ICU resources, and specialist availability of a Level I center.
ACS criteria include: GCS <14, penetrating injuries to head/neck/torso, hemodynamic instability, pelvic fractures, major burns, paralysis, and resource-limited situations.
Question 4: The mnemonic for trauma transfer communication is:
- SAMPLE
- MIST (Correct answer)
- AMPLE
- AVPU
Correct answer: MIST
MIST: Mechanism, Injuries, Signs/vital signs, Treatment given.
Additional communication should include demographics, past medical history, imaging results, lab values, ETA, and anticipated needs. Physician-to-physician communication is required.
Question 5: What legal obligation does a receiving hospital with capability have regarding trauma transfers?
- No obligation
- Must accept if they have capability and capacity (EMTALA) (Correct answer)
- May refuse if uninsured
- Only phone consultation required
Correct answer: Must accept if they have capability and capacity (EMTALA)
Under EMTALA, a hospital with specialized capabilities must accept appropriate transfers when it has capacity.
Violations carry penalties up to $50,000 per violation, loss of Medicare participation, and personal physician liability. Transfer agreements should be pre-established.
Question 6: Before helicopter transfer, which intervention must be completed?
- CT scan of all regions
- Decompression of any pneumothorax with chest tube (Correct answer)
- Definitive fixation of all fractures
- Complete crossmatch
Correct answer: Decompression of any pneumothorax with chest tube
Any pneumothorax must be decompressed before air transport because gas expands at altitude (Boyle's Law).
Also: air splints may over-inflate, ET tube cuffs should use saline not air, IV bags need pressure infusion. Helicopter cabins are pressurized to 5,000-8,000 feet equivalent.
ATLS Transfer to Definitive Care 2
What is the primary responsibility of the referring physician when transferring a trauma patient?