Published: 2019-10-24

Inter-hospital transfer of referred trauma patients admitted to the trauma centre of King George Medical University

Vikas Verma, Arpit Singh, Kumar Shantanu, Vineet Sharma


Background: Inter-hospital transfer is a common in trauma victims due to paucity of super-specialty care, lack of specialty beds, and lack of funding. The government of Uttar Pradesh introduced Emergency Medical Response system (EMRS). There is a need to audit and evaluate the transfer process since the introduction of the service. The objectives of this study were to identify critical gaps in the transfer of trauma patients and secondary over triage to the trauma centre of KGMU.

Methods: This prospective observational study was conducted on trauma victims referred to the trauma centre. Patients were evaluated for clinical status, Injury Severity Score, protective patient devices present, type of intravenous fluid infusion, mode of transport, and level of referring hospital. Transfer records, transport vehicles and accompanying personal were evaluated.

Results: Of the 342 patients enrolled in the study, 91 had a GCS score <8 and 112(32.74%) had a diastolic BP <60 mm Hg at arrival. Twenty patients (5.8%) were referred from tertiary care centers, 74(21.6%) were referred from district hospitals, 136(39.76%) were referred from primary care centers and 112(32.74%) were referred from private hospitals. Date and time of injury was not recorded in any of the patients. Referral time was recorded in 48(14.03%) patients. One hundred seventy-six patients (51.14%) were transferred in EMRS ambulances, 102(29.82%) patients met the criteria for secondary over triage.

Conclusions: There is a need to adopt and strictly implement guidelines for transfer of trauma victims to plug the critical gaps in the transfer process.


Inter-hospital, Referred, Transfer, Trauma

Full Text:



Wagner J, Iwashyna TJ, Kahn JM. Reasons underlying interhospital transfers to an academic medical intensive care unit. J Crit Care. 2013 April ; 28(2): 202–208. doi:10.1016/j.jcrc.2012.07.027.

Ivanusa M. Reducing mortality in myocardial infarction: Goal should be interhospital transfer for primary angioplasty. BMJ. 2005 May 28;330(7502):1271. DOI:10.1136/bmj.330.7502.1271-a

Aguirre FV, Varghese JJ, Kelley MP, Lam W, Lucore CL, Gill JB, et al. Rural interhospital transfer of ST-elevation myocardial infarction patients for percutaneous coronary revascularization: The Stat Heart Program. Circulation. 2008;117:1145–52

Warren J, Fromm RE, Jr, Orr RA, Rotello LC, Horst HM. American College of Critical Care Medicine. Guidelines for the inter-and intrahospital transport of critically ill patients. Crit Care Med. 2004 Jan;32(1):256-62.

American College of Emergency Physicians. Principles of appropriate patient transfer. Ann Emerg Med. 1990 Mar;19(3):337-8

Advanced trauma life support India program. List of ATLS® Certified Instructors Candidates available at on 16-06-2019 at 13:51

Ciesla DJ, Sava JA, Street JH, Jordan MH. Secondary over triage: a consequence of an immature trauma system. J Am Coll Surg. 2008 Jan;206(1):131-7. Epub 2007 Sep 17

Verma V, Singh G, Calvello E, Kumar S, Singh C, Harjai M. Inter-hospital transfer of trauma patients in a developing country: a prospective descriptive study. Indian J Community Health [Internet]. 30Sep.2013 [cited 11Jul.2019];25(3):309-15. Available from:

Gentleman D, Jennett B.Hazards of inter-hospital transfer of comatose head-injured patients. Lancet. 1981 Oct 17;2(8251):853-4. DOI:10.1016/s0140-6736(81)91115-6

Dunn LT. Secondary insults during the interhospital transfer of head-injured patients: an audit of transfers in the Mersey Region. Injury. 1997 Sep;28(7):427-31.

Arthur KR, Robertson M, Sims CA, Pascual JL, Reilly PM, Holena DN. Interhospital transfer: An independent risk factor for mortality in the surgical intensive care unit. Am Surg. 2013 Sep;79(9):909-13

Brain Trauma Foundation: American Association of Neurological Surgeons’ joint section on neurotrauma & critical care: Guidelines for the management of severe head injury. J Neurotrauma. 1996 Nov;13(11):641-734 DOI: 10.1089/neu.1996.13.641

Maas AIR et al. European Brain Injury Consortium – Guidelines for management of severe head injury in adults. Acta Neurochir (Wien). 1997;139(4):286-94.

Rajasulochana SR, Maurya DS. 108 in Crisis: Complacency and Compromise Undermine Emergency Services' Potential. Economic & Political Weekly. Vol. 53, Issue No. 25, 23 Jun, 2018 available at