For all critical and urgent care advice call NSW Aeromedical Control Centre (ACC) on 1800 650 004 or follow your local critical care escalation processes to support care delivered locally.
ADULT critical and specialist care inter-hospital transfer
Guidance on transferring urgent specialist or critical care adult patients to a higher level facility.
Patients may need to transfer when:
- they have, or are likely to, deteriorate without appropriate resuscitation and supportive management
- they have a life or limb threatening condition (immediate or urgent)
- they need clinical care outside the skill set or capabilities of the referring facility
- the referring facility can only provide temporary stabilisation and management.
NSW Health policies:
- Inter-facility Transfer Process for Adults Requiring Specialist Care (PD2011_031)
- Critical Care Tertiary Referral Networks and Transfer of Care (Adults) (PD2018_011)
Managing the ADULT patient waiting for retrieval or urgent transfer
Information for clinicians on a structured approach to requesting critical care advice and inter-hospital transfer. These resources include guidance on the assessment and clinical management of critical and specialist urgent care patients.
Common infusion table
Critical care advice teams and retrieval teams may advise you to commence vasoactive infusions while waiting for inter-hospital transfer. These medications can be administered via central or peripheral intravenous access.
1. Use 50 mL luer lock syringes with minimum volume tubing
- Prime lines after infusion syringe solution is drawn up
- Vasopressors can be administered peripherally in an emergency, recommended for less than 6 hours
- Vasopressors must be infused via pump with cardiac monitoring
2. Prepare infusions
May be administered peripherally while waiting for central access (less than 6 hours) unless otherwise indicated.
Drug | Dose | Dilution | Concentration | Infusion rate |
|---|---|---|---|---|
20 mg | Dilute to 40 mL with sodium chloride 0.9% | 0.5 mg/mL | Infuse at 0.5–10 mg/hour | |
Noradrenaline**(norephinephrine) | 3 mg | Dilute to 50 mL with glucose 5% | 60 microg/mL | Start at 2–10 microg/min |
Adrenaline** | 3 mg | Dilute to 50 mL with glucose 5% | 60 microg/mL | Start at 1–40 microg/min |
40 units | Dilute to 40 mL with glucose 5% | 1 unit/mL | Start 0.6 units/hr | |
400 mg OR 500 mg | Use undiluted (40 mL or 50 mL) | 10 mg/mL | Infuse at 1–3 mg/kg/hr | |
400 mg | Dilute to 40 mL with sodium chloride 0.9% | 10 mg/mL | 0.5–5 mg/kg/hr | |
50 mg | Dilute to 50 mL with sodium chloride 0.9% | 1 mg/mL | Infuse at 1–10 mL/hour | |
500 microg (and 50 mg) | Dilute to 50 mL with sodium chloride 0.9% | 10 microg/mL | Infuse at 1–10 mL/hour |
** Central administration recommended.
3. Titrate to effect
Clinical targets:
- Systolic BP > 90 mmHg
- MAP > 65 mmHg
- Urine output > 0.5 mL/kg/hr
- If hypotension is refractory to vasopressors (greater than one vasopressor required or rapidly increasing requirements) notify retrieval and/or ICU and seek further advice.
- If using peripheral vasopressor:
- monitor for signs of extravasation (for example, localised redness, swelling and tenderness)
- placement of central venous catheter is priority (if feasible and skilled staff are available).
Alternative infusion protocols: Peripheral vasopressors
1. Use 500 mL glucose 5% with infusion pump
- Prime lines after infusion solution is drawn up
- Vasopressors can be administered peripherally in an emergency, recommended for less than 6 hours
- Vasopressors must be infused via pump with cardiac monitoring
- Use a large peripheral vein at a proximal site on upper limb where possible
2. Prepare infusions
May be administered peripherally while awaiting central access (for less than 6 hours) unless otherwise indicated.
Drug | Dose | Dilution | Concentration | Infusion rate |
|---|---|---|---|---|
Noradrenaline**(norephinephrine) | 2 mg | Dilute to 500 mL with glucose 5% | 4 microg/mL | Start at 2–10 microg/min |
4 mg | Dilute to 500 mL with glucose 5% | 8 microg/mL | Start at 2–10 microg/min | |
Adrenaline** | 2 mg | Dilute to 500 mL with glucose 5% | 4 microg/mL | Start at 1–40 microg/min |
4 mg | Dilute to 500 mL with glucose 5% | 8 microg/mL | Start at 1–40 microg/min |
** Central administration recommended.
3. Titrate to effect
Clinical targets:
- Systolic BP > 90 mmHg
- MAP > 65 mmHg
- Urine output > 0.5 mL/kg/hr
- If hypotension is refractory to vasopressors (greater than one vasopressor required or rapidly increasing requirements) – notify retrieval and/or ICU and seek further advice.
- If using peripheral vasopressor:
- monitor for signs of extravasation (for example, localised redness, swelling and tenderness)
- placement of central venous catheter is priority (if feasible and skilled staff available).
Bariatric patients
In preparation for transport of bariatric patients, provide accurate information to the Aeromedical Control Centre (ACC) or NSW Ambulance. This includes the patient’s weight and maximum width.
All patients above 100 kg require a completed bariatric sizing chart.
Accessed from the Emergency Care Institute website at https://aci.health.nsw.gov.au/networks/eci/clinical/clinical-tools/retrieval-urgent-transfer