Harbor:Replantation Patients

For immediate clinical management see "Replantation"

Transfer Protocol

• Obtain a STAT Orthopedic Consult and page out as a TTA2 if not done already
  • Orthopedic consultant should come to the ED for emergent evaluation
    • The Orthopedic resident must staff with their attending prior to recommending transfer

• If the patient is deemed a potential replantation candidate:
  • The ED ATTENDING should call the MAC at 866-940-4401 and state:
    • "We are requesting an emergent/urgent transfer from HUMC ED to LAG ED for replant evaluation; I need you to arrange the transfer"
    • 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
  • MAC will connect the ED attending with the LAG Hand Call ATTENDING via recorded line to discuss the replant candidate transfer
    • The orthopedic consultant (senior resident) should be immediately available to answer any technical questions from the LAG Replant Surgeon on the recorded MAC line; if there is any discrepancy, the HUMC Ortho ATTENDING must speak with the LAG Hand ATTENDING
    • If the LAG Attending cannot be reached within 15 minutes, MAC will contact the LAG CMO/MOD and MAC Medical Supervisor to present the transfer request
    • If the transfer conversation is not initiated wihin 60 minutes, MAC will contact the DHS CMO
  • Once the 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.
      • MAC should arrange transportation via the Central Dispatch office; the ED clerk does NOT arrange transport for these patients
  • If MAC is unable to provide transport for Higher Level of Care Urgent/Emergent transfer within a reasonable amount of time (less than 2 hours) 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 LAG HAS AVAILABLE BEDS (even if closed to transfers per USC CMO Dr. Spellberg)

Gausche-Hill, Mahajan, Chappell, Wilhelm 7/1/24

Dealing with Disagreements Regarding Transfer

• If there is disagreement between HUCLA ED/Trauma/Ortho Consultant and Hand LAC+USC Replantation service about proceeding with replantation then HUCLA Ortho 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 Hand Attending [Admin on Duty (AOD)]
  • After in-person evaluation by the LAG re-plant surgeon, this may result in operative intervention
  • If the patient is deemed non-operative, the patient will either be discharged by LAG or returned via County Trans to HUMC (rare event)

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