Critical Care Admission To UK From Abroad
Memorandum of understanding - Critical care admission to UK from abroad
Repatriation from abroad of an NHS eligible critical care patient is ideally to the hospital closest to the patient's residential address in England.In the event that in addition to requiring critical care (intensive care), there is specialist organ support (burns or neurological or liver) or specific specialist service required that is not available in all hospitals (e.g.max fax, complex orthopaedics), then the nearest hospital (to the patient's normal place of residence) with that combination of services, is targeted . Usually the air repatriation service would be liaising on this with the lead medic speaking to the relevant lead medic for the appropriate unit. Patients usually need to be accepted as suitable for ITU admission by the designated consultant and the air retrieval/transfer planned. Occasionally it is necessary to repatriate to a neighbouring hospital rather than the closest depending on timing, bed availability and communications with the air repatriation service being used by the patient's insurers and this should be planned.
Critically ill patients transferred by air from abroad, who are NHS eligible, will fall into two categories:
- Patients transferred by insurance companies or governmental arrangement, by recognised aeromedical transfer companies with a knowledge of the UK medical system.
- Patients transferred ad hoc by unrecognised, often small and foreign-registered, aeromedical companies.
Patients transferred by recognised companies following their association code of conduct, should arrive with
- an agreed destination unit
- contact from the referring ICU abroad, with prior discussion and written transfer information.
- notification of departure and arrival times
- trained escort
Where there is prior discussion, it should be borne in mind by destination units that aviation departure arrangements are complex and do not allow flexibility for delay, or for prolonged negotiations depending on daily bed state, prioritisation vs elective surgical cases. It is likely to be in the best interests of the patent and their family, to adopt an "accept by any means possible" policy and commit to transfer, if the patient is clinically stable and appropriate to move.
Patients arriving by other companies are unregulated and may arrive with no warning, at any hospital. They may need to be treated as a critically ill A&E arrival and may need stabilisation and onward transfer. Duty of care must be borne in mind, and turning away the ambulance without treatment due to lack of notification, is not an acceptable option for the patient.