Planning and co-ordinating a transfer: DipIMC practice questions
PHEM curriculum unit 5.3 · Theme 5: Supporting Safe Patient Transfer
The DipIMC is blueprinted against phase 1 of the UK Pre-hospital Emergency Medicine (PHEM) curriculum. This page covers unit 5.3, Co-ordinate and plan patient transfer.
Below are 2 free practice questions from the DipIMC.Ninja bank, in the Part A single best answer format. Every answer names the textbook page, guideline or statute it was written from, so you can check it rather than take it on trust. The bank holds 23 questions on this unit.
Question 1 · Medical & Resuscitation · Moderate
A 58-year-old man in a district general hospital has a ruptured abdominal aortic aneurysm confirmed on CT. He needs immediate surgery at the regional vascular centre 30 minutes away. He is hypotensive and has been accepted by the vascular surgeon, but the receiving hospital has no level 3 critical care bed. What is the correct course of action?
- ADelay departure until a level 3 bed is confirmed at the vascular centre
- BTransfer him now for surgery, without waiting for a critical care bed
- CAsk the network to find another vascular centre with a free level 3 bed
- DTransfer him to the nearest hospital that has a free level 3 bed
- EAdmit him to the local intensive care unit and re-refer in the morning
Show answer
Answer: B
Transfer him now for surgery, without waiting for a critical care bed
ICS/FICM transfer guidance recommends that transfer for immediate lifesaving interventions must not be delayed by lack of availability of a critical care bed. The decision to transfer and to accept a patient must be made by appropriate consultants in both the referring and receiving hospitals, and here the receiving vascular surgeon has accepted. Waiting for a bed, or looking for a different vascular centre, spends time a ruptured aneurysm does not allow. Sending him to whichever hospital has a free bed takes him away from the surgery he needs, and admitting him locally to re-refer in the morning is a decision not to treat.
Where this comes from
med-015 · Medical & Resuscitation · Transfer · Moderate · v3
Question 2 · Medical & Resuscitation · Moderate
A 44-year-old woman with severe pneumonia is to be moved 40 minutes by road to a tertiary respiratory centre. She is intubated and ventilated on a fraction of inspired oxygen (FiO2) of 0.7, her base deficit is minus 9, and she is receiving noradrenaline at 0.3 micrograms/kg/min. Applying the ICS and FICM three-tier risk model, what is the minimum acceptable escort?
- AA registered nurse or practitioner with transfer competences, travelling without a doctor
- BA nurse or practitioner plus a doctor or advanced practitioner with transfer competences
- CTwo registered nurses, both holding critical care and inter-hospital transfer competences
- DA nurse or practitioner plus a doctor or advanced practitioner with critical care and airway skills
- EThe paramedic crew alone, with telephone access to the referring consultant throughout
Show answer
Answer: D
A nurse or practitioner plus a doctor or advanced practitioner with critical care and airway skills
Every variable here falls in the high-risk band of the ICS/FICM risk stratification tool: intubated and ventilated, FiO2 above 0.6, base deficit worse than −8, and vasopressor support above 0.2 (micrograms)/kg/min. High risk calls for a nurse or clinical practitioner plus a doctor or advanced practitioner with critical care and advanced airway competences; the West Yorkshire CCSTT tool gives the same escort. A nurse or practitioner plus a doctor or advanced practitioner with only general transfer competences is the medium-risk escort, which is the trap: nobody in it is required to have the airway skills this patient's already-instrumented airway demands. A lone nurse or practitioner is the low-risk escort. Two nurses, however experienced, or a crew with telephone advice, do not supply the required doctor or advanced practitioner. The risk assessment itself should be made by the referring consultant or senior clinician before departure.
Where this comes from
med-016 · Medical & Resuscitation · Transfer · Moderate · v4
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