Principles for repatriation

The Scottish Trauma Network (STN) has agreed the following principles for repatriation. These principles apply to all repatriations within the National Scottish Network.

• Patients are repatriated to their local area:
  • as soon as it is clinically safe and appropriate to do so.
  • when their condition is medical stable and they are clinically fit to travel as determined by the referring lead clinician and receiving clinician.
  • when their treatment in respect of major trauma care which required their admission to the Major Trauma Centre (MTC) or Trauma Unit (TU) is complete, or medical care is still required but the interests of the patient and family would be for that care to be closer to home e.g. repatriation to another Trauma Network or another country.
  • when the level of clinical care which they require can be provided in their local area.
• Planning for repatriation should start as early as possible by the MTC or TU multidisciplinary team and is an integral part of the Rehabilitation Pathway.
• Repatriation must occur in a timely manner to ensure the best use of bed capacity across the region and allow for patient recovery in a unit closer to home.
• Clinician to clinician discussion takes place to ensure that patients are repatriated to the most appropriate hospital/community setting within their local area.
• Once the agreement for repatriation is confirmed, the referring hospital will make a formal referral to the receiving hospital. The receiving hospital will automatically accept the patient and ensure a bed is available. The patient will be repatriated when all arrangements are in place within 48 hours of formal referral.
• Each MTC and TU will nominate a single point of contact (SPOC) to whom all referrals will made. If the referral is from outside the regional network it should be made to the MTC SPOC who will liaise with the relevant TU SPOC and team.
• A Rehabilitation Plan will accompany all patients transferring out of the MTC or TU.
• Delays should be escalated as soon as identified as per local escalation process to aid early resolution. DATIX forms should be completed if delays are experienced in order to highlight barriers and work towards improvement.
• Patients and/or relatives/carers will be informed of repatriation arrangements as soon as possible and will be informed of progress throughout.
• The Scottish Ambulance Service will repatriate stable patients from ward to ward using the scheduled care service. It is not the intention that patient repatriations will require clinical intervention on route and therefore paramedic level care will not be required. The scheduled care service is staffed by Ambulance Care Assistants who can provide basic first aid, administer up to 6L/min of oxygen and provide safe and comfortable transport of patients. Vehicles can accommodate patients on stretchers, seated patients, and patients in wheelchairs.

Immediate "hot" transfers

Transfers where patients arrive at a community facility, Local Emergency Hospital (LEH) or Trauma Unit (TU) and urgently need the services of a Major Trauma Centre (MTC).

• If a community facility, ScotSTAR will dispatch a resuscitation / transfer team from North or West bases.
• If remote or rural LEH or TU (including Dumfries, Raigmore, Elgin) transfer will be co-ordinated by the Specialist Services Desk (SSD) with air support as required.
• If semi-urban / urban Trauma Unit, transport will be arranged by contacting a dedicated number for urgent inter hospital transfers.  In the latter two categories, initial resuscitation would be carried out locally prior to transfer.
• In all cases a RED or PURPLE ambulance response will be assigned (highest categories). Network documents defining these transfers already exist (in North, South East and West of Scotland) and SAS will need to bring all these together into a nationally consistent response.

Transfers for specialist care

Other transfers for specialist care such as spinal injury, complex orthopaedics, maxillofacial and some neurosurgery will be arranged through SSD if remote / rural, or a dedicated SAS number if more central.

Repatriations

Typically patients would be repatriated from MTC to TU/LEH or from TU to LEH / community facility.

Responsibility for ensuring patients are adequately fit for travel will rest with the referring unit, but care of the patient in transit will rest with SAS staff.  Deterioration in transit would likely involve diverting to the nearest A&E department for stabilisation.