Ver el código de «Harbor:Replantation Patients»

''For immediate clinical management see "[[Replantation]]"''
=== [https://lacounty.sharepoint.com/:b:/t/EDOperations-HUCLA-5-JenandKelsey/EQZqEWzpwb9MsHyxQrYssJYBrBGw6WhoXSMky23Cti6m2Q?e=kid0Z9 Replant Flow Diagram] ===
==Transfer Protocol==
* Obtain a STAT Hand Call Consult and page out as a TTA2 if not done already
** Hand Call consultant should come to the ED for emergent evaluation
*** '''The Hand Call 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. [https://secure2.compliancebridge.com/lacdhs/DHSpublic/index.php?fuseaction=header.download&policyID=4374&descriptor=header1&doc=373.3.pdf 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 Hand Call 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 Hand Call ATTENDING must speak with the LAG Hand Call 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 [[https://wikem.org/wiki/DEM_Admin_on_Duty_(AOD)|DEM 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]]

[[Category:Admin]]