The target clientele
Trauma categories determining if a child/adolescent (0 to 18 years of age) needs to be transferred to a tertiary pediatric trauma centre:
- Child/adolescent who is intubated
- Child/adolescent with a head injury: signs of lateralization, Glasgow Coma scale < 14
- Child/adolescent with a mild head injury requiring observation
- Child/adolescent with a spinal cord injury
- Child/adolescent with a depressed or open skull fracture
- Child/adolescent with a burn (more than 15% TBSA, 2nd degree)
- Baby with a burn over 10% TBSA (nutritional needs)
- Child/adolescent with a burn on the face, hands or feet
- Child/adolescent with a burn on the perineum
- Child/adolescent with a major trauma who is hemodynamically stable
- Baby/infant (< 4 years old)
- Child/adolescent requiring complex and extensive reconstruction
- Child/adolescent with a Salter fracture or another serious type of fracture
- Child/adolescent with a major trauma requiring cardiovascular, renal or nutritional support
- Child/adolescent whose trauma is evaluated as non-accidental
Stabilization criteria before the transfer
Even in the case of an urgent transfer, the referring hospital must ensure that the child/adolescent is hemodynamically stable before transferring.
The following are signs of instability of vital signs in patients under 18 yeas of age:
- Respiratory rate under 10 or over 60 per minute;
- Systolic arterial tension under 70, over twice the patient's age in years;
- Heart rhythm:
If < 2 years, < 100 and > 160/min.
If between 2 and 10 years, < 80 and > 150/min.
If > 10 years, < 60 and > 140/min.
In the presence of an urgent medico-surgical condition where the trauma threatens the child/adolescent's organs or life, the transfer is to be done after stabilization.
The stabilization includes an adequate evaluation and the beginning of the treatment so that, with reasonable probability, the transfer does not result in death or serious damage to the vital functioning of one of the organs.
The stabilization of the patient must include, when required:
- Maintaining the permeability of the airways.
- Control of any haemorrhaging.
- Adequate immobilization of the patient or of a limb.
- Setting up intravenous access for the administration of a solution or blood product.
- Administering the necessary medication.
- Necessary measures to ensure optimal stability during transfer.
- Adequate accompaniment of the child by professionals deemed necessary to safeguard the life or corporal integrity of the patient during the transfer between the two hospital centres.
Modalities concerning the process for transferring to the MCH
Axis of communication to ensure transfer:
The emergentologist of the referring centre must communicate the request to the MCH ER Department, using the direct transfer line at (514) 412-4499.
Pertinent documents to submit with the transfer:
Initial pre-transfer information must be sent by fax to (514) 412-4399. In an ideal situation, this information should be sent before the patient's arrival at the MCH, using the polytrauma form and/or ER medical and nursing notes.
Documents to accompany the transfer:
- Pre-hospital information (ambulance, police), forms AS 803, AS 810, and others if necessary
- The standard trauma form or a legible copy of the physical exam of the patient by the physician, of the clinical evolution and any interventions carried out.
- Paraclinical exams: haematology, biochemistry, blood gas, medical imaging, ECG
- The identification of the referring hospital and the name and contact information of the emergentologist must clearly appear on the first page of the transfer documents.
If the referring centre encounters a problem and needs to quickly contact the responsible parties:
- Dr Harley Eisman, Medical Director of the Emergency Department,
(514) 412-4400 ext. 23039
- Nadia Eldaoud, Nurse Manager of the Emergency Department,
(514) 412-4400 ext. 22270
- Dr. Kenneth S. Shaw, Medical Director of the Trauma Program,
(514) 412-4388 between 9 am and 4 pm,
or by pager at (514) 406-4773
- Debbie Friedman, Director of the Trauma Programs,
(514) 412-4400 ext. 23310