Explosive Weapons Trauma Care Collective (EXTRACCT) Clinical Practice Guideline: Transfer of Critically Injured Casualties

Introduction: Blast-injured patients often present to healthcare facilities which cannot definitively meet their clinical needs. This clinical practice guideline (CPG) reviews and describes best practice for inter-facility transfer of casualties in resource limited and conflict-afflicted contexts where there may not be a formal referral pathway or specialized inter-facility transfer service. Methods: A narrative literature review and synthesis of expert opinion were used to develop this CPG. Results: The guideline describes current standards and best practice in inter-facility transfer in a low resource context—particularly during conflict when referral and transfer pathways may be overwhelmed—and advises on the selection and preparation of patients, as well as equipment and staff. Conclusion: This CPG outlines how clinicians can prepare to deliver the safest possible transfer in their context using a series of simple checklists and a flowchart to guide decision making. The evidence base for the CPG is limited by the lack of data on inter-facility transfers in resource-limited contexts and the difficulty in translating guidance from the global north into resource limited and conflict-afflicted contexts.