Harbor:Replantation Patients

For immediate clinical management see "Replantation"

Transfer Protocol

  • Obtain STAT Hand Call Consult and page out as TTA2 if not done already
    • Hand call consultant should come to ED for emergent evaluation
      • Rotates between Ortho, Plastics, check doc box for who is on for the day
      • For Plastics, ensure that senior resident has evaluated patient
  • If patient is deemed a potential replantation candidate, then
    • Hand consultant (senior resident or attending) should speak directly to LAC+USC Attending Replant Surgeon on the recorded MAC line to discuss replant candidate transfer acceptance
    • Once patient is accepted for transfer, ED provider coordinates further transfer logistics via MAC
    • ED provider to say: "We are requesting a Higher Level of Care Urgent/Emergent transfer to LAC+USC per DHS Policy 373.3".
      • This makes the request a priority and should get transfer approved within 60 minutes.
      • Ask MAC for ETA of transport.
    • If MAC is unable to provide transport for Higher Level of Care Urgent/Emergent transfer within a reasonable amount of time this issue should be escalated to the MAC Medical Officer of the Day (MOD), DEM Admin on Duty (AOD), and the Attending Trauma Surgeon
    • TRANSFERS FOR POTENTIAL REPLANTATION WILL PROCEED REGARDLESS OF WHETHER LAC+USC HAS AVAILABLE BEDS. (Even if closed to transfers for that reason per CMO Dr. Spellberg at LAC+USC)

Dealing with Disagreements Regarding Transfer

  • If there is disagreement between HUCLA ED/Trauma/Hand Call Consultatant and Hand LAC+USC Replantation service about proceeding with replantation then HUCLA Hand Call Attending must talk to LAC+USC Replantation Attending on the recorded MAC line.
  • If there continues to be disagreement - the patient WILL be accepted by LAC+USC for an in-person evaluation by the replantation service (per CMO's at LAC+USC and HUCLA) - please involve both Trauma Attending and DEM Admin on Duty (AOD)

Repatriation

  • If the patient is transferred to LAC+USC and after evaluation it is decided that replantation is not indicated - HUCLA WILL accept the patient back in transfer.


See Also