• R Wuerz and S Meador.
• Division of Emergency Medicine, Milton S. Hershey Medical Center, Pennsylvania State University, Hershey 17033, USA.
• Prehosp Disaster Med. 1994 Jan 1;9(1):50-3.

ObjectiveTo identify risk factors for adverse events that occur during interfacility transfers by advanced life support (ALS).DesignA four-year, retrospective, case series.SettingThree ALS units in a rural/suburban emergency medical services (EMS) system.Participants351 transports to or from twelve acute care facilities; two patients records could not be located.InterventionsPatients were classified by illness/injury, transporting staff, and ongoing therapy; these were correlated with frequency of ALS intervention and patient deterioration.ResultsDuring the study period, the number of transfers as a percentage of total calls (1.1%-5.2%) rose consistently. There were 11 illness/injury categories; the largest was cardiac (44%, 154 patients). Hospital staff accompanied the patient in 15% (52). Advanced life support (ALS) therapy was required in 4.9% (17): one monitored cardiac arrest was defibrillated successfully, 13 patients required unanticipated medication therapy, and three were noted to have clinical deterioration en route. The upper 95% confidence limit for cardiac arrest is 12.9/1,000 transfers or 20.8/1,000 hours. Patient deterioration and the need for ALS intervention were associated with the presence of medication infusions (p < .05), but not with hospital staff (p > .40).ConclusionsInterfacility transfers of a heterogeneous group of patients in this series involve a low risk of cardiac arrest. Patients with medication infusions are at higher risk of deterioration and more frequently require ALS intervention en route. The presence of hospital staff had no measurable effect. These findings have implications for the development of ALS transfer protocols.

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