London Ambulance Service NHS Trust

Medical Directorate Executive Office Headquarters 220 Waterloo Road London SE1 8SD

Tel: 020 7783 2083

IMPORTANT INFORMATION 13 September 2019.

TO: Emergency Departments Pan London.

FROM: London Ambulance Service.

Re: Inter-Facility Transfers

Dear Colleagues,

Every day there are many occasions when ambulance trusts are required to undertake an urgent or emergency conveyance of a patient as a result of a call from a healthcare professional (HCP) or from a healthcare facility (IFT). Currently the process for these transfers is subject to local arrangements.

As a component of the ARP two new national frameworks for the ambulance trust response to HCP and IFT requests for ambulance attendance and conveyance have been drafted by the Association of Ambulance Chief Executives and approved in collaboration with ambulance commissioners, NHS England and NHS Improvement and other key stakeholders. The purpose of these frameworks is to support the development of local agreements that are more consistent nationally and which provide HCP and IFT requested conveyance in a timeframe that is equitable with other patients accessing 999 ambulance services.

IFT New Process and Standards

There are now 4 levels of inter-facility response.

IFT Level 1 (IFT1) Category 1 This level of response should be reserved for those exceptional circumstances when a facility is unable to provide immediate life-saving clinical intervention such as resuscitation or in the case of a declared obstetric emergency and requires the clinical assistance of the ambulance service in addition to a transporting resource.

These requests should be made by phoning 999 where the call will be triaged by the ambulance service. Trying to bypass the questions asked by the emergency call handler will slow the dispatch of an ambulance. Examples in this category would include cardiac arrest, anaphylaxis, birthing units requiring immediate assistance or acute severe life-threatening asthma in an urgent care facility.

IFT Level 2 (IFT2) Category 2

This level of response is based on the clinical condition of the patient and the need, or a high likelihood of the need, for further treatment and management at the destination facility rather than the patient’s diagnosis. Immediately Life, Limb or Sight (globe trauma) Threatening (ILT) situations which require immediate management in another healthcare facility should receive this level of response.

Other examples in this category include patients going directly to theatre for immediate neurosurgery, primary percutaneous coronary intervention, stroke thrombolysis, surgery for ruptured aortic aneurysm, emergency laparotomy, surgery for ectopic pregnancy, limb or sight saving surgery or mental health patients being actively restrained.

IFT Level 1 and Level 2 incidents are clinically confirmed emergencies which require life-saving intervention and will be responded to as time critical emergencies and immediately allocated the nearest appropriate response.

IFT Level 3 (IFT3) – transfer within 2 hours

This level may be commissioned for patients who are not undergoing immediate life or limb saving interventions but require an increase in their level of clinical care as an emergency. This level of response may include mental health patient transfers or those for the purpose of creating a critical care bed.

IFT Level 4 (IFT4) – transfer within 4 hours This is for all other patients who do not fit the above definitions and require urgent transport for ongoing care but do not need to be managed as an emergency transfer. This includes patients being transferred to inpatient wards for ongoing management or for elective and semi elective procedures or investigations but who require an emergency ambulance. This category will be subject to clinician to clinician conversation as the majority of patients should be clinically suitable for transfer by the hospital PTS service.

 Patients who do not fit the definitions above are not appropriate for an IFT Level 1, 2 or 3 response from the ambulance trust.

 In some cases patients with immediately life or limb threatening conditions may not be ready for transfer within the IFT Level 1 or 2 timeframe and require further management before being clinically suitable for transfer.

 In this instance, a lower level of IFT response may be allocated to reflect the time delay until the patient is ready for transfer.

 It is the responsibility of the referring Acute Trust to ensure that the patient is accompanied by appropriate Healthcare Professionals (HCPs) who is able to undertake any treatment that may be needed during the journey – LAS is unable to guarantee a paramedic crew for transfers

 The patient and the accompanying HCP must be ready for transfer when LAS arrive – where the transfer is delayed more than 15 minutes the LAS crew will be stood down and the transfer will need to be re-booked.

 There is no guarantee the member of hospital staff will be returned to the hospital if the crew are tasked to another emergency call.

 Requests for inter-hospital transfers will be monitored by LAS and feedback provided to the Acute Trusts particularly where there is discrepancy between the information provided when the request is made and the clinical condition documented on the LAS patient report form

 Repatriations or step-down transfers/discharges to non-hospital facilities are not included in the IFT framework.

Should you require any further information please contact: David Macklin, LAS Deputy Medical Director (email: [email protected])

Yours Sincerely

Dr Fenella Wrigley QHP(c) MBBS MRCPCH FRCEM DipIMC RCSEd Mr Khadir Meer Chief Operating Officer Chief Medical Officer and EM Consultant

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