Proposed pathway for ScotSTAR as Single Point of Contact (SPOC)–secondary transfers

• All paediatric trauma patients who need transfer to PMTC (with the exception of stable, single-limb injury patients) will be phoned to SSD and ScotSTAR paediatric team.
• The ScotSTAR paediatric consultant and nurse will be added to the call. If the ScotSTAR paediatric consultant is unable to take the call, SSD will refer it to paediatric head of service (if available on base) or the appropriate PICU clinician, as is current policy.
• Depending on the nature of the injury and the location, the following will also be added to the call:
  • a. PMTC receiving consultant(s)
  • b. PICU receiving consultant if required
  • Any additional staff can be bought into the call as required.

• If time-critical patient, (IFT level 1), SSD would assist in organising urgent transfer and the referring centre would be expected to bring the patient. 
  • a. ScotSTAR/PICU/specialist advice to stabilise the patient
  • b. Referring centre clinician can come off the call to continue to treat and transfer the patient
  • c. ScotSTAR would be ongoing SPoC if advice required during transfer.

• If unstable patient (IFT level 2), discussion regarding following points: 
  • a. Location of patient and resources available locally, which would help decide if the transfer should be time-critical or able to be stabilised locally whilst awaiting ScotSTAR
  • b. Initial resuscitation and stabilisation advice given
  • c. Retrieval arranged with ScotSTAR if not time critical

• If stable patient(some IFT level 3 & 4, excluding stable, single specialty pathology), discussion regarding the following points: 
  • a. Treatment plan by the team during the call
  • b. Appropriate mode of transfer, depending on location and resources available

Stable paediatric patients with a peripheral extremity injury are excluded from the pathway above, as they do not require ScotSTAR input. These are patients who require ongoing management in a PMTC as the TU/LEH is unable to provide definitive care requiring a scheduled response transfer. These patients will be referred directly to their closest paediatric MTC and a road ambulance would be phoned after this discussion. The referring clinician will phone for a road ambulance transfer, using the Scottish Ambulance Service NOW criteria (Now; one or two hours; within four hours). As these referrals are stable and do not require the input of ScotSTAR or SSD, this avoids making unnecessary demands on these services and they can be arranged directly. Stable paediatric patients with a peripheral extremity injury in the North of Scotland will be referred to the SSD and paediatric ScotSTAR pathway. Whilst these patients will not require ScotSTAR retrieval, the retrieval logistics and distances involved in secondary retrieval in this region benefit from this process. The SSD desk will assist the referring unit in organising the transfer for this cohort of patients.

• This allows prompt multi-disciplinary discussion, formation of an appropriate plan for the patient and ensures a safe transfer. Involving all relevant individuals on the conference call is an efficient way of exchanging information.
• The ScotSTAR clinicians are used to managing such calls and will ensure that pertinent points are covered quickly with all relevant participants.
• This system is flexible enough to take into account local variations in each region regarding who is involved in the call conference and policy. It is also able to address any issues that require inter-regional consideration, for example if a PICU is full and cannot accept a patient.
• As this is a national system, inter-regional referrals for definitive care can be accessed in the same manner as referral to local PMTC and will not cause confusion.