If time does not allow for these steps prior to transfer, align the injured anatomy, apply a dressing and splint, and send the patient to the receiving trauma center. Obtain a photo of the hand and wound, or amputated part, and also a radiograph that may be used when communicating with the Midwest Admission and Transfer Center and the hand surgeon on call. Amputated parts should be prepared for transportation: Wrap in saline gauze and place in a plastic bag, and then place the bag on ice. X-ray the injury, when possible, while keeping in mind that bleeding, ischemia or amputation require immediate transfer and should not be delayed. Reduce obvious deformity: Align fingers if angled or rotated. Conduct primary care of the wound, including control of bleeding, irrigation, administration of antibiotics and elevation of the limb. Perform an initial trauma evaluation: The patient should be hemodynamically stable for transportation. When the patient has an isolated hand injury, it is helpful to consider the following steps: What should be done for a patient with a hand injury prior to transfer? Referring personnel may call the Midwest Admission and Transfer Center, 50, which will then contact the physician on call. If you have a patient with a hand injury and are in need of transfer or advice on treatment, a consult by phone may be appropriate. In these types of cases, such as with a finger laceration that may include tendon injury, the initial wound care may be provided at the referring hospital with antibiotics and a splint until seen by the hand surgeon. We have found during our phone conversations that readily available pictures of the hand and wound, as well as radiographs, greatly facilitates the decision and activation of the transfer process.Īt times, an injury requires a hand surgeon, but perhaps the definitive treatment can wait several hours or a day. Open fractures, multiple finger injuries, and complex wounds and infections also may require immediate transfer. It's also important to take the patient's age into account when considering transfer for a hand injury, especially in amputations, as consideration for replantation is greater with younger patients. In general, ischemia, multiple digit injuries and amputations are the primary reasons for immediate transfer. These questions can be answered using the Isolated Hand Injury Algorithm-Hand Referral for Acute Care Management graphic, which helps providers consider patient age, injury location and severity, and thumb or multiple-digit injury or amputation, all of which may identify need for transfer. 
Isolated Hand Injury Algorithm-Hand Referral for Acute Care Management Isolated Hand Injury Algorithm-Hand Referral for Acute Care Management.
What patients need to see a hand specialist immediately? How would you suggest trauma providers decide if a patient needs to be transferred to a Level I center? Dennison responds to some of the most common issues that arise with hand injury transfer decisions in the community. Fortunately, through the Midwest Admission and Transfer Center, surrounding facilities can call to discuss cases that are in need of urgent referral. With all the potential variations in hand injuries, it is sometimes challenging to understand what the actual issue may be, as many of those calling to refer patients are often health care providers who are not trained in the care of hand injuries. The use of guidelines helps capture all urgent conditions and review injuries that may still need to be seen soon, perhaps the next day, if initial care can be provided at the referring hospital or clinic. It is important to understand the urgent need of referral for some injuries and to know what conditions can be safely temporized overnight. Dennison, M.D., a hand surgeon at Mayo Clinic's campus in Rochester, Minnesota, reports that while the hand surgeons at Mayo Clinic receive many urgent transfers, there are patients with injuries who can be managed initially at an outside hospital or clinic and then referred to be seen the next day.
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