1. 1. TRANSFER OF AN ILL OBSTETRICSPATIENTDR ALIFAHO&g Specialist
2. 2. INTRODUCTION Sarawak is the largest state in Malaysia witha land mass almost equal to PeninsularMalaysia
3. 3. CHALLENGES..1. TOPOGRAPHY 3. TRANSPORTATION2. DISTANCES 4. LOGISTIC
4. 4. INTER-HOSPITAL TRANSFER OF AN ILLOBSTETRIC PATIENTS POSES ANADDITIONAL RISK TO THE PATIENTHOSPITAL SARIKEI HOSPITAL SIBU
5. 5. 1.DECISSION TO TRANSFER
6. 6. EARLY AND APPROPRIATE REFERRAL Early referral O&G specialist- DISTRICT MO BUDDY SPECIALIST- HEALTH CENTRES without MO -->SPECIALIST Occasionally simultaneous referral to otherspecialties may be necessary(eg:anaesthetist/ physician/ surgeon)
7. 7. RISK OF TRANSFERRING? The decission to transfer patient in remoteparts may be decided on the risk involved intransferring (eg:night transfer) O&G specialist may decide againsttransferring the patient or delay the transfertill the next day if the risk of transfer is higherthan managing the case in the referringcentre
8. 8. 2. STABILISATION BEFORE TRANSFER
9. 9. Ensure the patient is stabilised as best aspossible prior to transfer1.IV lines/ branula2.IV infussion / bloods
10. 10. 3. Medications- anti HPT, MgSO4, Inotropes4. Oxygen support/ intubation5. In PPH- may need Bakri baloon
11. 11. THE SPECIALIST SHOULD PROVIDE THEAPPROPRIATE INSTRUCTIONS ORGUIDANCE TO THE REFERRINGDOCTOR/ NURSE
12. 12. 3. MODE OF TRANSPORTATION
13. 13. The following needs to be considered whendeciding on the best mode of transportationa) Urgency of transferb) Condition of the patientc) Availability of ambulance/ other mode oftransportd) Distance and estimated transit timee) Time of day & weatherf) MEDEVAC is an option but enquire first if itcan respond quickly enough
14. 14. 1.LAND TRANSPORTATION Distance to Hospital Sibu about 45 minutesto 1 hour Condition of road
15. 15. 2. AIR TRANSPORTATION MEDEVAC- Decision should be discussed with O&Gspecialist JKNS- Considerations include:1. Severity of the cases2. Availability of the helicopter3. Weather
16. 16. KK BINTANGOR(25 MINS)KK RUSA(30 MINS)KK BALAI(40 MINS)KK BAYONG(45 MINS)KK MAONG(5 HOURS)KK ENSIRING(5 HOURS)KK ENTABAI(3 HOURS)KK SEKALUNG(2 HOURS)KK JULAU(1 HOUR)KK LASSI(45 MINS)KK ENTAIH(2 HOURS 30MINS)KK PAKAN(45 MINS)KK KARA(2 HOURS)KK WAK(1 H 15 MINS)
17. 17. 4. DRUGS & EQUIPMENT
18. 18. Ensure the ambulance or transport have therequired resuscitative equipments that is ingood working order (availability of oxygentank) Ensure the staff escorting the patient knowshow to operate the resuscitative equipments
19. 19. Ensure the appropriate medications(eg:MgSO4, parenteral anti-HPT, sedatives,muscle relaxants) which are needed shouldbe prepared in prefilled syringes Crossmatch blood products to bring along ifindicated
20. 20. If the patient is intubated ensure the Oxylogis functioning or adequate oxygen tanks toensure the oxygen supply is adequate NG tube is inserted to avoid aspiration duringtransfer
21. 21. 5. PERSONNEL
22. 22. Ensure that the relevant personnel arealerted early (eg:ambulance driver, escortingMO/SN, blood bank staffs) In fact, obstetric drills may include scenarioinvolving patient transfer All escorting staff should have at leastaccreditation in BLS and ideally passedSALSO They must be able to recognise and addressany deterioration They must be familiar with drugs andequipment involved during transfer
23. 23. 6. HANDING OVER
24. 24. This should be done systematicallythroughout all levels- Escorting MO Referral centre MO/Specialist- Escorting SN/ MA Referral centre SN Proper communication & documentation isvital
25. 25. Sibu Hospital Retrieval Team- Aim: to retrieve ill cases from clinics ordistrict and bring them back to the specialisthospital- The specialist/ consultant would make thedecission if the retrieval team should beactivated and depends on case to case basis
26. 26. BENEFITS- O&G team can perform surgery in districthospitals before taking patients back to thespecialist hospital- Team can optimise patient during transfer- Team can manage complications better duringtransfer- Additional blood products- Anaesthetic doctor could come along in therelevant cases DISADVANTAGES- Longer time taken to transfer patient
27. 27. CHECKLIST BEFORE DEPARTURES1. INTUBATED PATIENT- Oxylog functioning- Adequate O2 supply- ETT anchored- Suction machine- Nasogastric tube- Oropharyngeal airways- High flow mask/ambubag- Drugs-Muscle relaxantand sedation
28. 28. 2. EQUIPMENT/MONITORING- SpO2/BP monitorbattery charged- Infusion pumpscharged- Resuscitation bagcomplete3.MEDICATIONS- IV MgS04- Anti- HPT- Inotropes- Crystalloids or Colloids- Anti-emetic
29. 29. 4. BLOOD PRODUCTS- Packed cell- Whole blood5. OTHERS-Case notes/ films/ charts-Emergency contact/Relative informed
30. 30. THANK YOU..