Explosive Weapons Trauma Care Collective (EXTRACCT) Clinical Practice Guideline: Transfer of Critically Injured Casualties.

Abstract

Blast-injured patients often present to healthcare facilities which cannot definitively meet their clinical needs. This clinical practice guideline (CPG) reviews and describes best practice for inter-facility transfer of casualties in resource limited and conflict-afflicted contexts where there may not be a formal referral pathway or specialized inter-facility transfer service. A narrative literature review and synthesis of expert opinion were used to develop this CPG. The guideline describes current standards and best practice in inter-facility transfer in a low resource context-particularly during conflict when referral and transfer pathways may be overwhelmed-and advises on the selection and preparation of patients, as well as equipment and staff. This CPG outlines how clinicians can prepare to deliver the safest possible transfer in their context using a series of simple checklists and a flowchart to guide decision making. The evidence base for the CPG is limited by the lack of data on inter-facility transfers in resource-limited contexts and the difficulty in translating guidance from the global north into resource limited and conflict-afflicted contexts.