Principles of transfer medicine: DipIMC practice questions

PHEM curriculum unit 5.1 · 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 5.1, Understand the concepts underpinning transfer medicine.

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 11 questions on this unit.

Question 1 · Medical & Resuscitation · Moderate

A neonatal transport service is asked to move a sick term baby who needs intensive care not available locally. Which statement about the NHS England neonatal critical care transport standards is correct?

AThe service need operate only in weekday daytime hours, with night transfers left to local crews
BThe service also undertakes in-utero transfers of the mother when the baby will need uplift
CParents may not travel with the baby, and are given written information about the transport service instead
DFor intensive care uplift, the team must reach the baby within one hour on 95% of occasions
EFor time-critical transfers, the team departs within one hour of the referring call on 95% of occasions

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Answer: E

For time-critical transfers, the team departs within one hour of the referring call on 95% of occasions

The NHS England neonatal specification sets a mobilisation standard for time-critical transfers: the team departs from base, mobilising towards the patient, within one hour from the start of the referring call on 95% of occasions annually. The separate referral response standard is for the team to arrive with the baby within 3.5 hours of the referring call, for intensive care uplift, on 80% of occasions — so reaching the baby within an hour is not the standard. The service operates 24 hours a day, every day. In-utero transfers are not undertaken by neonatal transport services; they are initiated and guided by maternity teams. When appropriate and safe, at least one parent or legal carer is allowed to accompany the baby, and parents are also given written information.

Where this comes from

Neonatal critical care (transport) service specificationNHS England·Key outcomes: mobilisation time“towards the patient within one hour from the start of the referring call”Open PDF at page 3
Neonatal critical care (transport) service specificationNHS England·Key outcomes: referral response time“within 3.5 hours of the referring call on 80% of occasions”Open PDF at page 3
Neonatal critical care (transport) service specificationNHS England·Service description: hours of operation“Operate 24 hour per day, every day”Open PDF at page 4
Neonatal critical care (transport) service specificationNHS England·Parents travelling with the baby“at least one parent / legal carer will be allowed to”Open PDF at page 7
Neonatal critical care (transport) service specificationNHS England·Exclusions: in-utero transfers“In utero-transfers are not undertaken by neonatal transport services.”Open PDF at page 11
Neonatal critical care (transport) service specificationNHS England·Scope: in-utero transfers are a maternity responsibility“In-utero (IUTs) are initiated and guided by the maternity teams.”Open PDF at page 5

med-024 · Medical & Resuscitation · Transfer · Moderate · v2

Question 2 · Medical & Resuscitation · Moderate

A retrieval service is tasked to a small island health centre staffed by a nurse, with basic monitoring and a few oxygen cylinders but no critical care, laboratory or imaging facilities. A critically injured fisherman has been brought there by boat. Using the terminology of the ABC of Prehospital Emergency Medicine, how is this mission best classified?

APrimary retrieval from the scene of the injury
BModified primary retrieval from a basic facility
CSecondary retrieval between two health facilities
DTertiary retrieval for access to subspecialty care
EWinch primary retrieval from an inaccessible site

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Answer: B

Modified primary retrieval from a basic facility

The ABC (Ch. 32) classifies retrievals as primary (from a pre-hospital site to a health facility, subdivided into 'land on' or 'winch' depending on site access) or secondary (from one health facility to another, also called interfacility transfers); movement between large centres for subspecialty services is sometimes called 'tertiary'. It adds the term 'modified primary' for an interfacility transfer where the referring centre has only rudimentary facilities: for all intents this is a primary retrieval with shelter and power. The label matters because it drives resourcing — crew mix, platform and equipment should be planned as for a primary mission, not for a transfer from a hospital with critical care support, imaging and pathology. Beware that the Oxford Handbook of Pre-Hospital Care (Table 13.1) uses a different scheme, in which moving a patient from a basic health care facility to one with more advanced facilities is called secondary retrieval, tertiary is secondary-to-tertiary care and quaternary is repatriation from abroad. The key here depends on the ABC terminology named in the stem.

Where this comes from

ABC of Prehospital Emergency Medicinep. 172Ch. 32 Retrieval and Transport · Definitions and terminology“The term ‘modified primary’ has also emerged”
Oxford Handbook of Pre-Hospital Carep. 717Ch. 13 Patient rescue and transportation · Transport in pre-hospital care, Table 13.1 Different types of retrieval“Retrieval from a basic health care facility to one with more advanced facilities”
ABC of Prehospital Emergency Medicinep. 172Ch. 32 Retrieval and Transport · Definitions and terminology“involves an interfacility transfer where the referring centre has only rudimentary facilities”

med-187 · Medical & Resuscitation · Transfer · Moderate · v1

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Principles of transfer medicine: DipIMC practice questions

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