Transfer to Hospital

The transfer of casualties to the hospital will depend on the type of emergency medical service deployed. Some countries such as France deploy medical personnel with the ambulance response teams, and these can provide definitive early life-support and antidote treatment whilst delaying transfer. Other paramedically operated ambulance services have an early transfer to the hospital as a priority, delaying treatment until reaching the emergency department. Factors affecting transfer include the number and severity of contaminated casualties, location of the incident, weather conditions, distance to the appropriate medical facilities and the resources available. 

Vehicles taking casualties to the hospital should take a route that does not pass through any contaminated areas or plumes. Vehicles used to transport contaminated casualties should be separated from other vehicles and used only for the incident. All equipment and devices used during the incident should be kept together in order to facilitate comprehensive decontamination at the end of the incident. Past experience has shown that there can be secondary contamination from the use of contaminated equipment, clothing or vehicles. 

Advance warning for any receiving hospitals is essential so that emergency procedures can be implemented. It is important to note that casualties may have self-evacuated and may arrive at the hospital or the emergency department without warning. Consequently, prompt action is always necessary. Information is needed 

---

In all cases the patient should be transferred to hospital or to a doctor, for further treatment of the wound, and also for a course of anti-tetanus toxoid, which is indicated if the patient is not already fully immunised. 

Remove the patient to the fresh air, and loosen clothing at the neck. If breathing has stopped or is extremely w eak, gh e artificial respiration and continue until the patient is transferred to hospital or until a doctor arrives. 

If the patient is in a state of shock (f.e., pale, faint or collapsed, sweating, cold) treat by lying flat, or preferably with the legs raised approximately one foot, loosen clothing around the neck, keep warm but not hot (one to two blankets) and transfer to hospital or obtain medical attention urgently ... 

First aid is to reassure the patient and arrange transfer to hospital as quickly and passively as possible. It is recommended that a bitten limb be immobilised by a pad and bandage, and there is experimental evidence for this approach although traditional first aid treatments are useless and often dangerous. 

GPs are advised to give benzylpenicillin before urgent transfer to hospital, particularly if meningococcal disease is suspected. Due to increasing resistance to penicillin in pneumococci and H. influenzae, the third-generation... 

Supportive treatment suffices for the majority of cases. Activated charcoal by mouth is indicated to prevent further absorption from the alimentary tract and may be given to the conscious patient in the home prior to transfer to hospital. Convulsions are less likely if unnecessary stimuli are avoided but severe or frequent seizures often preceed cardiac arrhythmias and arrest, and their suppression with diazepam is important. The temptation to treat cardiac arrhythmias ought to be resisted if cardiac output and tissue perfusion are adequate. Correction of hypoxia with oxygen and acidosis by i.v. infusion of sodixim bicarbonate are reasonable first measures and usually suffice. 

The basic concept of operations envisages that contaminated casualties who are rescued or self-evacuate from the heavily contaminated hot zone should be rapidly undressed, triaged (Fisher et al, 1999), given basic life support treatment and decontaminated in the warm zone before being passed to the cold zone for fuller assessment, treatment and, if necessary, subsequent transfer to hospital. 

In 1965, after Frumkin had been transferred to hospital after a heart attack, he started to think about some unsolved problems posed in his early studies back in the 1930s. As a result, he revisited the thermodynamic theory of the perfectly polarizable electrode, and its experimental checkup then appeared [31, 32]. These studies were carried out by O. A. Petrii and coworkers at the Department of Electrochemistry MSU. This not only resulted in the development of some new experimental techniques (e.g., potentiometric titrations under isoelectric conditions) but also led... 

Permissive - advanced pre-hospital care is possible (cold zone) but transfer to hospital must not be delayed. 

Intravenous access may be obtained if this does not delay transfer to hospital. Sufficient fluids (usually 0.9% saline) should be given, in 250 ml aliquots, to maintain the presence of a palpable radial pulse. A more vigorous fluid regime is appropriate if there is evidence of significant head injury and copious fluids should be administered if the casualty has been crushed. 

Never allow pre-hospital care to delay transfer to hospital... 

The paper presented different design and manufacturing methods with associated hardware and software options which were successfully implemented for clinical cases. Selection of the right work-flow will lead to the reasonable implant cost and effectively use the available resources. In this way, technology transfer to hospitals will be more and more convenient. Finally, the presented approaches will be useftil for hospitals, universities and companies when considering investments about hardware and software which are necessary for developing BME applications for diagnosis and treatment of bone defects. 

Texas, learning to be a proper Regular Army Officer followed thereafter by a hoped-for transfer to Walter Reed Army Hospital in Washington,... 

During surgery on the heart, it is cooled to about 32-33 °C by surrounding it with a slush of ice or by infusion of the coronary arteries with a cold solution. Either treatment stops contractions of the heart. In addition, it lowers the metabohc rate so that glycolysis in cardiomyocytes is reduced and they are protected from damage that could be caused by lactic acid. For the same reason, an organ for transplantation is transferred between hospitals at a low temperature (4°C). Some hospitals now use ice to cool the head in patients admitted with trauma to the head. These manipulations are successful despite the fact that a decrease in temperature from 37 °C to about 30 °C is only 2.3% on the Kelvin scale. 

Transfer to disopyramide Use the regular maintenance schedule, without a loading dose, 6 to 12 hours after the last dose of quinidine or 3 to 6 hours after the last dose of procainamide. Where withdrawal of quinidine or procainamide is likely to produce life-threatening arrhythmias, consider hospitalization. 

Transfer to flecainide Theoretically, when transferring patients from another antiarrhythmic to flecainide, allow at least 2 to 4 plasma half-lives to elapse for the drug being discontinued before starting flecainide at the usual dosage. Consider hospitalization of patients in whom withdrawal of a previous antiarrhythmic is likely to produce life-threatening arrhythmias. 

Slow continuous infusion - Give at a rate of 3 mL/min (2 mg/min). Continue infusion until satisfactory response is obtained then discontinue infusion and start oral labetalol. Effective IV dose range is 50 to 200 mg, up to 300 mg. Transfer to oral dosing (hospitalized patients) Begin oral dosing when supine diastolic BP begins to rise. Recommended initial dose is 200 mg, then 200 or 400... 

Parenteral Therapy in the hospitalized patient may be initiated IV or IM. Use parenterally only when the drug cannot be given orally. Usual dose is 20 to 40 mg, repeated as necessary. Certain patients (especially those with marked renal damage) may require a lower dose. Check blood pressure frequently it may begin to fall within a few minutes after injection average maximal decrease occurs in 10 to 80 minutes. Where there is a previously existing increased intracranial pressure, lowering the blood pressure may increase cerebral ischemia. Most patients can transfer to the oral form in 24 to 48 hours. 

A second subject (6849) experienced a grand mal seizure 3 h after receiving 300 mg of 2-PAM (chloride form) intramuscularly. He regained consciousness within 5 min he had bitten his tongue. He was initially lethargic, but felt well 10 h later. He was transferred to Walter Reed Hospital, but followup records are not available. He had received 300 mg of 2-PAM intramuscularly 5 and 8 d before the episode. The only symptom on those occasions was local pain at the injection site. 

To increase the number of beds available, the planned non-emergency hospitalization to surgical departments was put on hold and patients who recovered and patients waiting for non-urgent planned operations were either discharged or transferred to non-surgical departments. 

---