Gentleman and Jennett gave a checklist that can be used before transferring a patient with a severe head injury to another hospital with a neurosurgical unit. This can reduce the risk of preventable morbidity and mortality during the transfer. The authors are from the Institute of Neurological Sciences in Glasgow.



(1) respiration

(2) circulation

(3) head injury

(4) other injuries

(5) patient escort



(1) ThePaO2 should be at least 100 mm Hg.

(2) The PaCO2 should be less than or equal to 40 mm Hg.

(3) The airway should clear.

(4) The airway should be adequately protected during the transfer.

(5) The intubated and ventilated patient requires special provision for the transfer.



(1) The systolic blood pressure is at least 120 mm Hg.

(2) The pulse is less than or equal to 100 beats per minute.

(3) The patient should show evidence of adequate peripheral perfusion.

(4) There should be a reliable intravenous line in place before leaving.

(5) The patient should have been received adequate blood and fluid replacement to replace losses.


Head injury:

(1) The Glasgow coma score (GCS) should be determined before transfer.

(2) The Glasgow coma scale should be monitored during the transfer to detect signs of deterioration.

(3) The patient should be evaluated for focal neurological signs prior to transfer.

(4) The patient should be evaluated for any skull fracture prior to transfer.


Other injuries - The patient should be evaluated prior to the transfer for:

(1) cervical spine injury

(2) chest injury

(3) pneumothorax

(4) broken ribs

(5) intrathoracic hemorrhage

(6) intra-abdominal bleeding

(7) pelvic fracture

(8) long bone fracture

Any lesion identified should be stabilized prior to transfer.


Patient escort:

(1) The escorting physician and nurse should be experienced in the care of trauma patients.

(2) The escorting physician and nurse should be carefully instructed what specifically to do for the patient.

(3) The escort vehicle should carry adequate equipment and medications to meet any need during the transfer.

(4) The patient's medical record and imaging studies should be sent along with the patient.


Additional instructions (not in original table):

(1) The escorting personnel should fully document their evaluation of the patient during the transfer.

(2) Other transfer protocols emphasize the need to communicate with the receiving hospital prior to making the transfer.


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