Specialist team retrieval of head injured patients: fact, fiction, or formula?

• Published in: Intensive care medicine 2009-02, Vol.35 (2), p.334-338
• Main Authors: Dieppe, Clare, Lo, T. Y. Milly, McFadzean, Jillian, Rowney, David A.
• Format: Article
• Language: English
• Subjects: Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Anesthesiology; Biological and medical sciences; Child; Clinical Audit; Clinical death. Palliative care. Organ gift and preservation; Craniocerebral Trauma - epidemiology; Craniocerebral Trauma - therapy; Critical Care Medicine; Emergency Medicine; Feasibility Studies; Head injuries; Hospitals; Humans; Intensive; Intensive care; Intensive care medicine; Medical sciences; Medicine; Medicine & Public Health; Pain Medicine; Patient Care Team; Patient Transfer - statistics & numerical data; Pediatric Original; Pediatrics; Pneumology/Respiratory System; Prospective Studies; Teams; Time Factors; United Kingdom - epidemiology
• ISSN: 0342-4642; 1432-1238
• DOI: 10.1007/s00134-008-1323-1

Objective This feasibility study aimed to determine the maximum theoretical distance the Edinburgh Paediatric Retrieval Team (EPRT) could travel to retrieve head injured children without additional delay in reaching definitive care. Design A prospective audit was conducted over 2 years to determine the current practice for paediatric head injury transfers (stabilisation, referral, and transfer time) undertaken by primary hospital staff, and the performance (mobilisation and travel time) of the EPRT. A novel formula was devised and used to determine the theoretical maximum radius within which the EPRT could reach a referring hospital during their stabilisation of head injured patients. Measurements and results During the study period, 27 head injured patients were transferred to our unit by road and the EPRT conducted 194 road retrievals. The median stabilisation time for the head injured patients was 3.6 h. Median time to refer these patients to neurosurgical services was 1 h after presenting to primary hospitals. Median mobilisation time for EPRT was 1 h. Using our novel formula, 67 miles was the theoretical maximum radius within which the EPRT could reach a referring hospital during their stabilisation of head injured patients. Conclusions Specialist team retrieval of paediatric head injury is a possibility, but not without significant organisational changes such as availability of second teams, early referral of patients and utilisation of the mobilisation time as a cancellation window. Our novel formula offers other teams a starting point to assess their own performance and to develop services.