Meeting the standards for interhospital transfer of adults with severe head injury in the United Kingdom

In December 1996, the Association of Anaesthetists of Great Britain and Ire land produced a series of recommendations outlining the safe conduct of int erhospital transfers for patients with acute head injuries. We assessed the current ability of UK hospitals to implement these recommendations and opi nions on the formation of transfer teams, using a postal questionnaire. Thi s was sent to all Royal College of Anaesthetists tutors, 268 of whom replie d (94% response rate). Of the hospitals surveyed, 208 received adult head-i njury patients but did not have on-site neurosurgical facilities. In 171 (8 6.8%) of these hospitals, senior house officers could be expected to accomp any the patient during subsequent transfer. The majority of hospitals (192, 92.3%) were able to monitor ECG, pulse oximetry and blood pressure during the journey, but only 97 (46.6%) had facilities to monitor end tidal carbon dioxide levels. As a result of the anaesthetist's involvement in the trans fer, emergency operating could be delayed in 169 (81.3%) hospitals. One hun dred and fifty-eight (76%) respondents thought that the formation of transf er teams to transport critically ill patients would have some merit. Hospit als are responding to the published guidelines, but improvements are still needed in levels of equipment and insurance provision, along with the ident ification of a designated consultant at each hospital with responsibility f or transfers.