Clinical Handover is essential in any transfer in order to provide continuity in patient care and should be conducted in accordance with the Clinical Handover Procedure.

In the context of interfactility transfers, the handover must follow the ISOBAR principles and be inclusive of (but not limited to):

• An adequate summary of the patient’s condition and level of acuity
• Current treatment
• Possible complications that could affect patient care in transit
• The transfer plan, as agreed by the treating team

This information should be conveyed verbally at the bedside and in a face to face fashion from the Doctor / Nurse in charge of the patient’s care and documented on the Interhospital Patient Transfer form (in ePCR or downloaded copy). Transfer paperwork (summary, lab work, x-rays, etc.) should be given to St John personnel prior to commencement of the transfer. The patient, family and or friends should be consulted regarding the transfer where appropriate.

If a nursing or medical escort is accompanying the patient, crew roles and responsibilities for the patient transfer should be discussed and be clear prior to commencement of the transfer.

In cases of an unexpected medical incident, unfamiliarity with vehicle layout and pre-hospital equipment by escorting medical teams poses a risk to patient safety and may hinder good patient outcomes. Where practicable, and to mitigate this risk, the attendant should be in the rear of the vehicle during the transfer. This may not be possible in specific circumstances, and should be included in the discussion regarding roles and responsibilities. The agreed plan should be documented.

It is essential that St John WA staff know the accepting doctor (or team) and the desired transport destination prior to departure.

The receiving physician should be contacted by the transferring physician, prior to transfer, with any updates and an expected estimated time of arrival.

The level of trained staff used to transfer a patient should be appropriate to the treatment necessary or anticipated during transfer. It may be appropriate for the hospital to send specifically trained personnel to accompany the patient. Crew mix requirements and role designations should be dictated by and commensurate with clinical transfer plan, patient acuity and the clinical needs of the patient. It is a requirement of St John WA that the most senior medical escort travel with patients in the patient compartment.

Team Roles

• St John WA
  • Carrying out patient care and monitoring
  • Documenting observations
  • Operating the vehicle & SJWA equipment
• Nurse
  • Managing Intravenous infusions
  • Assisting with patient care and monitoring
• Doctor
  • Overseeing patient care

The Doctor is the team leader and final decision maker. All opinions and concerns by all team members need to be freely expressed at all times.

Graded Assertiveness

Bring to attention
e.g. "The oxygen saturations are decreasing "

Enquire
e.g. "You're not going to cannulate that fractured arm, are you?"

Clarify
e.g. "I feel uncomfortable about this; please explain what you are doing."

In critical or dangerous situations, demand a response or take control
e.g. "LISTEN!" or "Stop – you must listen to me."

Staff must be comfortable that they have sufficient information to accept responsibility of a patient with ongoing medication administration. Instructions for oral, IM or IV maintenance should be provided for the St John WA staff.

Written instructions MUST be given on the Special Medication Authority section of the checklist for any medication not covered in St John WA Medication Protocols. Direction should also be sought from the transferring hospital or CSPSOC with regards to the disposal requirements of medications not covered by SJWA Medication Protocols.

Electronic infusion devices may be managed by St John WA staff without the need for an escort, however the following information is required:

• A direct contact number for attending doctor if more information becomes necessary
• A tutorial is given on how to adjust rates, turn the alarm off or stop the infusion as required
• Familiarity with Clinical Skill – IV Pumps

If presented with an IV infusion, the key questions to address are:

• What medication?
• What would be the effect if the flow rate was adjusted?
• What would be the effect if during the journey it stopped?
  • If the effects of stopping the infusion or altering the infusion rate are life-threatening or severe, a suitable escort is required.