Definitive care of the seriously injured casualty requires transfer to an operating theatre or intensive care unit (ICU), often via the radiology department for scans. This may require transfer to another hospital. Safe transfer requires:
• a stable patient - this is not always possible. If a patient is hypovolaemic from a ruptured spleen rapid transfer to an operating theatre and immediate surgery is needed to stop the bleeding;
• trained personnel to monitor and manage changes in the patient's condition during transfer;
• communication - the receiving hospital or department should know that you are coming. Copies of notes, X-rays and any cross-matched blood should accompany the patient;
• monitoring equipment - the same monitoring as used in the initial management of the patient is continued during transfer. This requires robust, portable lightweight monitors with adequate battery life;
• oxygen and supplies - there should be enough oxygen in the cylinders and drug and fluid supplies to complete the journey.
Finally, the tetanus immunity status of the casualty should be checked. If there is no history available the casualty should be considered unimmunised. Antibiotic therapy needs to be started in those with wounds and injuries where there is a high risk of infection.
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