Knowledge

Indications, risks and benefits of patient transfer (intra / inter hospital)
Criteria for admission to, and discharge from ICU - factors influencing intensity and site of care (ward, high dependency unit (HDU), intensive care unit (ICU))
Principles of safe patient transfer (before, during and after)
Strategies to manage the unique problems associated with patient transfer - limitations of space, personnel, monitoring & equipment
Advantages and disadvantages of road ambulance, fixed and rotary wing aircraft including problems associated with altitude, noise, lighting conditions, vibration, acceleration and deceleration
Selection of mode of transport based upon clinical requirements, distance, vehicle availability and environmental conditions
Determination of required number of physicians / nurses / others during transfer and the role of paramedical personnel
Selection and operation of transport equipment: size, weight, portability, power supply/battery life, oxygen availability, durability and performance under conditions of transport
Principles of monitoring under transport conditions
Physiology associated with air transport
Homeostatic interaction between patient and environment (e.g. thermoregulation, posture / positioning)
Communication prior to and during transport
Operation of locally available retrieval services
Potential psychological impact of inter-hospital transfer and family dislocation

Skills & Behaviours

Determine when the patient's needs exceed local resources or specialist expertise (requirement for transfer)
Take decisions to admit, discharge or transfer patients
Communicate with referring and receiving institutions and teams
Check transfer equipment and plan transfers with personnel prior to departure
Select appropriate staff based upon patient need
Prepare patients prior to transfer; anticipate and prevent complications during transfer - maintain patient safety at all times
Adapt and apply general retrieval principles where appropriate to pre-, intra-, and inter-hospital transportation.
Consider the need for stabilisation before transfer
Undertake intra-hospital transfer of ventilated patients to theatre or for diagnostic procedures (e.g. CT)
Undertake inter-hospital transfers of patients with single or multiple organ failure
Maintain comprehensive documentation of the patient's clinical condition before, during and after transport including relevant medical conditions, therapy delivered, environmental factors and logistical difficulties encountered
Lead, delegate and supervise others appropriately according to experience and role

Attitudes

Appreciates the importance of communication between referring, transporting and receiving staff
Anticipates and prevents problems during transfer
Desire to minimise patient distress
Recognises personal limitations, seeks and accepts assistance or supervision (knows how, when and who to ask)
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Basic Sciences also underpin the competencies within this domain. These are presented in full in the Basic Sciences Syllabus.