Stabilization of patients prior to interhospital transfer.

With regionalization of specialized health care services, some patients must be transferred between hospital to receive needed care. The authors evaluated 100 transfers to their emergency department as to the adequacy of stabilization prior to transport. Problems were identified in the areas of communication (nine cases), oxygenation (two cases), cardiac monitoring (one case), intravenous lines (eight cases), airway (two cases), ventilation (one case), equipment and personnel accompanying the patient (one case), bladder catheterization (four cases), nasogastric suctioning (one case), radiographs (nine cases), and spinal immobilization (seven cases). Because more than one error occurred in some patients, the total number of patients having problems with stabilization was 28. The authors also compared the reimbursement status of transferred patients with that of the region's and emergency department's patient populations. No evidence was found that financially undesirable patients were being preferentially transferred. Thus, even when transfers are not made because of unfavorable reimbursement status, many errors in stabilization occur. A review of the literature shows that inadequacies in stabilization for transfer are widespread. This may be improved through physician education, use of transport teams, and judicious use of interhospital transport. The indications and responsibilities of transfer are discussed.

Blunt trauma: combined anterior urethral and bladder ruptures in one patient.

The combined injuries of bladder rupture and anterior urethral tear without evidence of pelvic fracture or perineal injury are described. The injuries, the result of blunt trauma, were successfully repaired surgically. This combination has not previously been noted at the Shock Trauma Center of the Maryland Institute for Emergency Medical Services Systems (MIEMSS), a major regional center for blunt trauma.