Amputation - digits:  Isolated digit amputations should not be accepted by the ED Attending.  At the direction of he ED Attending EMS will page the on call Hand Attending who will determine if the patient can be accepted, usually determined by whether replantation is appropriate.

Aortic Aneurysms:  Patients with an aortic aneurysm should be accepted by the ED attending.  Once the transfer is coordinated, the Vascular Attending should be contacted to inform them of the transfer.  When the patient is en route back to SBUH and is approximately 10 minutes from arrival this same Vascular Attending should be notified of the patient's impending arrival.

Burn Patients:  Burn patients should be accepted by the ED Attending and EMS will coordinate the transfer.  Once the transfer is coordinated, the Burn Attending on call should be notified about the transfer.

ENT Patients:  Isolated ENT patients should not be accepted by the ED Attending.  At the direction of the ED Attending EMS will page the on call ENT Attending who will determine if they can accept the patient.

General Surgical Patients:  For patients with life threatening general surgical conditions the ED attending should accept the patient if the other hospital does not have a surgeon on call.  If the hospital has a surgeon on call then they must have their surgeon come in to see their patient and if they then want to transfer the patient that surgeon will call here and will be conferenced with our surgeon.  The two surgeons can then determine if transfer is appropriate.  Once the transfer is coordinated the SBUH Attending Surgeon should be contacted to inform them of the transfer.  When the patient is 10 minutes from arrival this Surgeon should be notified of the patient's impending arrival.

Interventional Neurosurgery  If Dr. Woo (interventional neurosurgery) accepts a patient in transfer EMS will immediately begin the transfer. We will attempt to get an inpatient bed (presuming it is appropriate that the patient goes to an inpatient bed) while the transport is in progress. If no bed is available the patient will be brought to the ED. EMS will notify the ED attending and the ED charge nurse that this type of transport is occurring.

Neurosurgical Patients:  Isolated neurosurgical patients should be accepted by the ED Attending only if the sending hospital does not have neurosurgical capability.  Once accepted EMS will coordinate the transfer.  DO NOT notify the SBUH neurosurgeon on call until the patient arrives here and you feel you need their consult.  If a referring hospital has a neurosurgeon on call then they must have their on call neurosurgeon come in to see their patient and if they then want to transfer the patient that neurosurgeon will call here and will be conferenced with our neurosurgeon.  The two neurosurgeons can then determine if transfer is appropriate.

Ophthalmology Patients:  Isolated eye injuries should not be accepted by the ED Attending.  At the direction of the ED Attending EMS will page the on call Ophthalmology Attending who will determine if they can accept the patient.

Orthopedic Patients:  Isolated orthopedic patients can be accepted by the ED Attending if the sending hospital does not have orthopedic services.  Once accepted EMS will coordinate the transfer and the senior ortho resident on call should be notified about the transfer.  If a referring hospital has an orthopedist on call then they must have their on call orthopedist come in to see their patient and if they then want to transfer the patient that orthopedist will call here and will be conferenced with our orthopedist.  The two orthopedists can then determine if transfer is appropriate.

ST Elevation MI Patients:  Emergent ST Elevation MI patients should be accepted by the ED Attending and EMS will coordinate the transfer.  If the patient meets Code H criteria, as determined by the ED Attending, a Code H should be called ASAP (do not wait until the team arrives at the sending hospital to call the Code H.  (If the ETA with the patient is greater than 1 hour, the Code H should be delayed until the patient is 1 hour from arrival.)  The cardiology fellow should be notified about any emergent cardiac patient accepted either via the Code H system or via a direct page.

Trauma Patients:  Multiple trauma patients should be accepted by the ED Attending and EMS will coordinate the transfer.  Once the transfer is coordinated the Trauma Attending on call should be notified about the transfer.  It is appropriate to call a Code T approximately 10 minutes prior to the patient's arrival if the patient meets Code T criteria.

Vascular Patients:  For patients with general surgical and vascular conditions which are life or limb threatening the ED attending should accept the patient and EMS will coordinate the transfer.  Once the transfer is coordinated the Surgical or Vascular Attending should be contacted to inform them of the transfer.  When the patient is en route back to SBUH and is approximately 10 minutes from arrival this same Surgical or Vascular Attending should be notified of the patient's impending arrival.