Role of a paramedic in inter-hospital transfer

Noor Shaarif Rayyan

Emergency Care Technician, Ambulance & Emergency Services, Kauvery Hospital, Chennai, India

As soon as I got over with my daily routine work, as I was wrapping up and getting ready to go home, my phone rang. I immediately gathered that I have been paged to transport a patient from the critical care unit of our hospital to another hospital.

I went to the ICU to assess the patient I was to transfer. I picked up the discharge summary, glanced through it, and received a short formal briefing on the patient’s status from the ICU staff nurse. I mumbled to myself, “This sounds like a pretty sick patient”. I was being asked to transport these 33 year-aged young ladies diagnosed with a condition that placed her in a high-risk category for inter-hospital transfer. I proceeded to make a quick but thorough assessment of her status and fitness for transfer.

The young lady, who looked very worried, was already connected to HFNC (high flow nasal cannula). I could also notice that there were a lot of wires going around the patient’s body. I figured out that she had an arterial line, central line, and a foley’s catheter in situ.

With the necessary clinical information of the patient programmed into my mind, I went back to the ED to grab the essential equipment needed to facilitate this transfer which included a portable ventilator, a monitor, and pumps, and headed back to the ICU.

She was kept on the IV fluids as they were essential for this patient – they were needed to go on during transit, to prevent her from deteriorating further. We had a small discussion about a trial of NIV for the patient. The monitors were connected and necessary supports like IV medication, and inotropes were fixed. Now, one last visual sweep at the monitor displayed stable vital parameters at that moment, it was time to slide the patient onto the ambulance stretcher, and shift the patient to the ambulance for the transfer to another hospital.

After shifting the patient into the ambulance, and ensuring that all the necessary monitors, oxygen support, and infusions were fully operational, we started our journey to the other hospital. During the journey, the anxious attenders kept enquiring about the patient’s vitals and health condition repeatedly. With a professional smile, I calmly explained the current situation of the patient.

The loud wailing of the siren, the continuous beep of the monitor, and the lubb-dub (of my own heart), were all in sync and I could sense that we were all on high alert, making me wonder “what could possibly go wrong here?” I was trying to anticipate issues that might crop up and take the situation from bad to worse.

Suddenly, I heard my name being called – my pilot was saying that we had reached the destination (hospital). Throughout the transport, the patient was holding on to her vitals and never deteriorated. It was just about half an hour of travel, but it seemed like an eternity, an endless journey, for me. At the destination hospital, I safely shifted the patient to the ICU, with all the support on flow. There, I introduced myself and gave a proper formal handling over regarding the patient’s present condition and what was done so far. We shifted the patient to the ICU bed at the receiving hospital. Finally, once I received the signature of the receiving doctor onto my trip chart, I took a deep breath, and heaved a sigh of relief, as I knew from my previous experience – that transfers like this don’t always go according to plan!

The safe transfer of a patient to another hospital is the most important task assigned to a paramedic technician. We make a thorough assessment of the patient’s clinical condition and gauge the prognosis based on set criteria. We determine whether they are high-risk patients for transfer or not. If they fit the criteria for a high-risk transfer, a high-risk consent is obtained from the attender by explaining the patient’s condition and all the risks involved to the patient during the transfer. The decision to transfer the patient is based a variable number of factors, but the core of the decision and action depends on what is available at another facility to deal with the potential complications of the illness, especially in a critically ill patient. The transportation of such critically ill patients should always be very carefully and safely handled and should not pose any additional risk.

As a paramedic, I should be ready for anything at any time. We have to act accordingly to the call of the moment. During the transport, the paramedics solely responsible for the patient’s status and safety. The stress we go through this can’t be explained in words, but all these stresses vanish after we see look of relief on the patient’s face. That is the reward we get from the patient and that makes us feel is satisfied about a job well done.