Harbor:Replantation Patients

For immediate clinical management see "Replantation"

Transfer Protocol

• Obtain STAT Hand Call Consult and page out as TTA2 if not done already
  • Hand call consultant should come to ED for emergent evaluation
    • Rotates between Ortho, Plastics, check doc box for who is on for the day
    • For Plastics, ensure that senior resident has evaluated patient
• If patient is deemed a potential replantation candidate, then
  • ED Provider to call the Medical Alert Center (MAC) (866)940-4401 and state: "We are requesting an emergent/urgent transfer for replant evaluation at LAC+USC".
    • All Emergent/Urgent requests should get transfer approval/dispositioned within 60 minutes. DHS Policy 373.3 MAC Transfers
    • MAC will ask for below info (at a minimum)
      • Patient’s name + MRN
      • Primary diagnosis
      • Reason for transfer
      • Triage status: Emergent/Urgent
      • Name of transferring (sending) attending physician and the name of the DEM AOD***
      • Location: ED room number
  • Hand consultant (senior resident or attending) should speak directly to LAC+USC Attending Replant Surgeon on the recorded MAC line to discuss replant candidate transfer acceptance
  • Once patient is accepted for transfer, ED provider coordinates further transfer logistics via MAC
    • Ask MAC for ETA of transport.
      • Estimated Transport Arrival times:
        • Basic Life Support (BLS) – Transport – This level of transport consists of two (2) Emergency Medical Technician I’s (EMT-Is). The average estimated time of arrival (ETA) for a BLS Unit is 30-45 minutes.
        • Advanced Life Support (ALS) or Critical Care Transport (CCT) – This level of transport requires ALS personnel (EMT Paramedic (EMT-P) or nurse). The average EMT-P ETA is 45 minutes, and 120 minutes for a nurse staffed ambulance.
  • If MAC is unable to provide transport for Higher Level of Care Urgent/Emergent transfer within a reasonable amount of time this issue should be escalated to the MAC Medical Officer of the Day (MOD), DEM Admin on Duty (AOD), and the Attending Trauma Surgeon
  • TRANSFERS FOR POTENTIAL REPLANTATION WILL PROCEED REGARDLESS OF WHETHER LAC+USC HAS AVAILABLE BEDS. (Even if closed to transfers for that reason per CMO Dr. Spellberg at LAC+USC)

• Dealing with Disagreements Regarding Transfer
  • If there is disagreement between the attendings regarding transfer acceptance, the patient WILL be accepted by LAC+USC for an in-person evaluation by the replantation service (per CMO's at LAC+USC and HUCLA) - please involve both Trauma Attending and [Admin on Duty (AOD)]

Dealing with Disagreements Regarding Transfer

• If there is disagreement between HUCLA ED/Trauma/Hand Call Consultatant and Hand LAC+USC Replantation service about proceeding with replantation then HUCLA Hand Call Attending must talk to LAC+USC Replantation Attending on the recorded MAC line.
• If there continues to be disagreement - the patient WILL be accepted by LAC+USC for an in-person evaluation by the replantation service (per CMO's at LAC+USC and HUCLA) - please involve both Trauma Attending and DEM Admin on Duty (AOD)

Repatriation

• If the patient is transferred to LAC+USC and after evaluation it is decided that replantation is not indicated - HUCLA WILL accept the patient back in transfer.

See Also

• Harbor:Main