Inter-hospital transfer of trauma patients in a developing country: a prospective descriptive study.
There is no standardised protocol for the transfer of injured patients in Jamaica, a process that is well known to be potentially hazardous. We undertook this study to evaluate the inter-hospital transfer process of injured patients in this developing country.


METHODS
A prospective descriptive analytical study of all consecutive patients transferred to the University Hospital of the West Indies from other hospitals was conducted over six months. Data were collected on specially designed proformas and analysed using SPSS version 10.0.


RESULTS
Of 122 patients studied, 79.5% were male and the mean age was 27.8+/-20.7 years. Most injuries resulted from road traffic accidents (40.2%), falls (27.1%) and assaults (26.2%). Several problems with the transfer process were identified. There was poor documentation of clinical parameters at referring institutions, with records of pulse rates in 13.1% (16/122), blood pressure in 9.8% (12/122), respiratory rate in 9.8% (12/122), Glasgow Coma Score in 10.6% (13/122) and pupillary reaction in 4.9% (6/122) of cases. Transfer arrangements were made by junior medical officers in 93.4% (114/122) of cases while consultants requested only 3.3% (4/122) of transfers. Public hospital ambulances transported 91.8% (112/122) of patients and 7.4% (9/122) were transported by helicopter. These vehicles were equipped with facilities for oxygen administration in 99.2% (121/122) of cases and sphygmomanometers in 91% (111/122) of cases, but functional capacity for suction was only present in 50% of vehicles. These critically ill patients were accompanied by physicians in only 11.5% (14/122) of cases, while 68.9% (84/122) were accompanied only by nurses.


CONCLUSIONS
The transfer of injured patients is not being performed in a manner consistent with modern medical practice. There is urgent need for implementation of a standardised protocol for the transfer of such patients in Jamaica.
Crandon
Ivor W
IW
The Department of Surgery, Radiology, Anaesthesia and Intensive Care, The University Hospital of the West Indies, Mona, Kingston 7, Jamaica.
Harding
Hyacinth E
HE
Williams
Eric W
EW
Cawich
Shamir O
SO
D000063:Accidents, Traffic / Q000401:mortality; D000293:Adolescent; D000328:Adult; D017732:Air Ambulances / Q000706:statistics & numerical data*; D000552:Ambulances / Q000706:statistics & numerical data; D002648:Child; D015331:Cohort Studies; D003906:Developing Countries; D004632:Emergency Medical Services / Q000592:standards / Q000639:trends; D005260:Female; D015600:Glasgow Coma Scale; D006785:Hospitals, University; D006801:Humans; D015601:Injury Severity Score; D007563:Jamaica; D008297:Male; D008875:Middle Aged; D020380:Needs Assessment; D017063:Outcome Assessment, Health Care; D010360:Patient Transfer / Q000592:standards / Q000639:trends*; D011446:Prospective Studies; D018570:Risk Assessment; D012959:Socioeconomic Factors; D016019:Survival Analysis; D016896:Treatment Outcome; D014947:Wounds and Injuries / Q000175:diagnosis / Q000401:mortality* / Q000628:therapy*; D055815:Young Adult