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Modern burn care is centralised, and studies show that early, prompt referral to dedicated burn services improve clinical outcomes. We describe the use of a novel clinical instrument, the burn injury Transfer Feedback Form, to support and educate referring clinicians about the early assessment and management of burn injuries. Since 2005, Transfer Feedback Forms have been completed for all burn-injured patients with inter-hospital transfer to a specialised burn unit in the state of New South Wales (NSW), Australia. The aim of this study was to review physiological, procedural, and system or process issues in the care of both adult and paediatric burn-injured patients needing retrieval and transfer in NSW as identified by the Transfer Feedback Form. Secondary objectives were to determine any significant differences in these parameters between metropolitan and regional or remote referring institutions, and if any improvements occurred in these parameters over time. This was a retrospective analysis of all patients who were transferred to a burn unit in NSW between July 2005 and July 2021 using their prospectively completed Transfer Feedback Forms. Patients were divided into metropolitan and non-metropolitan referral sources based on geographic location. Clinical issues or deficiencies identified during each patient transfer were then classified into various groups. To determine if transfer-related clinical concerns had changed with time, two distinct periods before and after 2015, when the NSW Trauma App was introduced, were analysed. We compared trends in frequency of transfer-related concerns before and after App introduction by using interrupted time series analysis. A total of 3233 patients had Feedback Forms submitted during the 16-year period. We included 929 children (28.7%) and 2304 adults (71.3%). Transfer-related clinical issues were identified in 904 adults (39.0%) and 484 children (52.0%). In both adult and paediatric patients, the most common transfer-related clinical deficiency was in relation to burn size estimation with 525 patients (43.7%) and 207 patients (30.6%), respectively. Between the time periods analysed, the number of issues arising during inter-hospital transfer fell significantly for both adults (from 46.1% to 26.1%; p < 0.05) and children (from 55.3% to 40.7%; p < 0.05). Segmented regression analysis demonstrated a significant break in the rate of transfer-related clinical issues in 2014 (p < 0.05) and 2015 (p < 0.01) for adults. Accurate body surface area estimations also increased significantly by 53% and 50% for adults and children (p < 0.05 for both), respectively, after 2015. Our analysis indicates that the early care of burn-injured patients undergoing inter-hospital transfer is associated with clinical, technical, and logistical challenges. However, introduction of the burn injury Transfer Feedback Form has been associated with improvements in early burn care by referring centres both temporally and geographically. Smartphone-based applications such as the NSW Trauma App have also probably contributed to these findings. Adopting these simple, inexpensive strategies into burn care systems will augment inter-hospital transfer of burn-injured patients, and improve clinical outcomes. • There are clinical and logistical challenges with burn patients undergoing hospital transfer. • We describe a novel instrument for providing feedback to referring clinicians. • Improvements have been seen in early burn care both temporally and geographically. • Smartphone-based applications (e.g. NSW Trauma App) have also contributed. [ABSTRACT FROM AUTHOR]

Aim: To evaluate the experience of NETS (The Newborn and paediatric Emergency Transport Service) New South Wales (NSW) with children referred with a provisional diagnosis of croup. To examine the adherence of referral hospitals to NSW Health policy guidelines and to establish criteria for the need to transfer and the level of escort required for a child with croup to a higher level of care. Methods: A retrospective audit of all children with a provisional diagnosis of croup referred to NETS over the epoch: 2005–2015. The NETS database was searched for keywords: croup and laryngotracheitis. Demographics, retrieval characteristics and management strategies were collected. Results: A total of 432 patients were identified. The number of children triaged to a medically led NETS team for transfer decreased (P < 0.001) whilst those transferred into more local regional or metropolitan hospitals (P < 0.001) increased. The number of adrenaline doses was not associated with intensive care admissions or the need for invasive ventilation. Conclusion: Medically led retrieval teams are not necessary for safe transfer of children with a provisional diagnosis of croup unless the airway is secured with an endotracheal tube. Transfer to more local hospitals for paediatric care should be considered and time allowed for medications to take effect prior to movement. [ABSTRACT FROM AUTHOR]

Catastrophic hemorrhage remains the leading cause of preventable death. Not all New South Wales (NSW) hospitals stock blood products and, as such, blood products carried by NSW Ambulance retrieval teams are often the first available to critically unwell patients. To describe the trends, characteristics and predictors of mortality prior to hospital treatment in patients receiving prehospital blood transfusion by NSW Ambulance retrieval teams attending primary missions from 2009–2018. Retrospective review of all patients who received blood products with NSW Ambulance retrieval teams between 13/8/2009 and 31/12/2018. A total of 12,468 primary taskings were reviewed, identifying 1,043 (8.4%) cases of prehospital transfusion. The proportion of missions administering blood transfusions doubled between 2009 and 2018. Road traffic incidents were the predominant etiology. Eighty per cent of patients (n = 842) reached hospital alive following transfusion. Retrieval missions had a median time of 117 minutes (IQR 74–168). An initial blood pressure <100mmHg and reduced GCS were strongly associated with prehospital mortality. The median shock index of patients prior to transfusion was 1.2, which reduced to 1.0 after transfusion. The use of prehospital blood transfusion for suspected bleeding in NSW Australia has more than doubled since 2010. Patients who received prehospital transfusion arrived at hospital with improved hemodynamic observations. [ABSTRACT FROM AUTHOR]

Background: Ambulance service blood transfusion is an area of rapid development. In New South Wales, Australia, the blood products carried by ambulance medical teams are often the first available to patients with critical bleeding. In addition to the blood products routinely carried by these teams, the Service created and implemented a method of initiating large‐volume, mixed‐product transfusions using existing blood banks: the Retrieval Transfusion Procedure (RTP). This article describes the trends and characteristics of New South Wales Ambulance RTP activations. Materials and Methods: This retrospective database review examines the patient records for all RTP activations. Key areas of investigation include logistics, product requests, population demographics, etiologies, physiology, mission timings, and transfusions. Results: Ambulance medical teams attended 27 531 missions in the reviewed period, 1573 patients received transfusion, and there were 138 RTP activations. Blood products were sourced from 40 banks and transported by police (46.7%), ambulance (27.1%), and helicopter (13.0%) to refueling stops (39.2%), prehospital scenes (24.2%) and hospitals (15.8%). The median time engaged on each mission was 189 minutes for metropolitan and 222 minutes for rural locations. Seventy‐eight patients were transfused with RTP blood products; 83.3% were traumas, of which 63.1% were motor vehicle collisions. Up to 18 units of blood products were administered before hospital arrival. There was significant (P <.001) improvement in the mean shock index of transfused patients between the first and final observations recorded. Conclusions: Ambulance service extended blood product transfusion is logistically achievable and facilitates emergency transfusions throughout the state with minimal additional infrastructure. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to explore the analgesic regimes adopted in our contemporary retrieval practice and the incidence of vomiting in ED after prehospital analgesic use. Method: A retrospective review was conducted on trauma patients retrieved by the Hunter Primary Retrieval Service in the Hunter New England Local Health District, New South Wales, Australia, during 2015. Results: Of the 379 patients attended by the service in 2015, 196 of them (mean age 38.6, SD 19.68, years) were selected for this review.Morphine was the most commonly used analgesic (mean 68.37%; 95% CI 61.36- 74.81%), followed by fentanyl (mean 48.47%; 95% CI 41.29-55.70%) and ketamine (mean 34.18%; 95% CI 27.57-41.28%). Fourteen (7.14%, 95% CI 3.96-11.69%) patients vomited either prehospital or within the ED. Patients in both the emesis and the non-emesis group were comparable in demographics. None of the three studied analgesics were observed to be significantly associated with higher risk of vomiting than the others in this review, although a higher dose of fentanyl was given to the non-emesis group (P = 0.04). Conclusions: The frequency of vomiting in the retrieved patients observed in our study was less than previously reported in the literature. Opioids still prevailed over ketamine as the preferred initial analgesic, with ketamine most commonly used as an adjunct. Multi-centre trials in this field would be preferable in future in view of the relatively low incidence of vomiting in retrieved trauma patients. [ABSTRACT FROM AUTHOR]

Objectives The aim of this study was to describe patient demographics, injuries, physiology and interventions performed by retrieval physicians in the care of burns patients in both a pre-hospital and interhospital setting. Methods A retrospective review of patient records from a large Australian Helicopter Emergency Medical Service was conducted. Demographics, injury, burn type, physiology and intervention data were extracted into a database for statistical analysis. Basic descriptive statistics were calculated, and patient physiology measures were compared at arrival and destination. Results A total of 490 burns cases were identified from a 5 year period (January 2010-August 2015). The majority (78.6%) were interhospital transfers conducted by road (49.4%) or helicopter (36.9%). Patients were predominantly men (75.7%) with a median age of 37 years (interquartile range [ IQR] 23-50). Median estimated total body surface area burned was 15% ( IQR 8.5-20) and 18% ( IQR 10-30) in pre-hospital and interhospital groups, respectively; however, retrieval physicians tended to overestimate total body surface area burned in comparison to destination burns units. Flash burn or explosion were the predominant aetiology of burn (49.4%), although the majority (95.3%) of patients had no associated traumatic injuries. Sixty patients were intubated by the Service. Escharotomies were performed on eight occasions resulting in improvement in circulation or ventilation. Overall mortality was 3.7% at 24 h. Conclusions The Service cares for 80-100 burns patients annually, a proportion of whom require complex interventions such as intubation and escharotomy, which was performed by retrieval physicians appropriately. Associated traumatic injuries were infrequent in patients who sustained burns from flashes or explosions. [ABSTRACT FROM AUTHOR]

Purpose: A retrieval program was developed in New South Wales (NSW), Australia to provide extracorporeal membrane oxygenation support (ECMO) for the safe transport of adults with severe, acute respiratory or cardiac failure. We describe the development and results of this program and the impact of the 2009 H1N1 epidemic on this service. Methods: An observational study of all patients who were retrieved on ECMO support in NSW, from March 1, 2007 to June 1, 2010, was carried out. Results: Forty adult patients were retrieved on ECMO support (median age 34 years). The indications for retrieval were respiratory in 38 patients (of whom 16 were confirmed or suspected H1N1 cases) and cardiac in 2 patients. Two other patients died after referral but before ECMO support could be established. Patients were transported by road ( n = 26, 65%), medical retrieval jet ( n = 10, 25%) and helicopter ( n = 4, 10%). The median retrieval distance was 250 km (range 12-1,960 km). Thirty-four patients (85%) survived to hospital discharge. Survival for respiratory indications was 87% (33/38 patients) and 50% (1/2 patients) for cardiac indications. There were no deaths or major morbidity associated with these retrievals. Conclusions: Patients with very severe respiratory failure, which was considered to preclude conventional ventilation for safe transfer to tertiary centres, were managed by an ECMO referral and retrieval program in NSW and had a high rate of survival. This program also enhanced the capacity of the state to respond to a surge in demand for ECMO support due to the H1N1 epidemic, although the role of ECMO in respiratory failure is not yet well defined. [ABSTRACT FROM AUTHOR]

Summary: Rates of obesity are rising throughout the world. Obese patients have a number of co-morbidities and associated diseases which can impact the safe transportation of these patients. This overview of the retrieval of bariatric or obese patients will explain some of the physiological and different co-morbidities found in these patients, as well as some more practical advice when faced with transporting these patients. [ABSTRACT FROM AUTHOR]