What are the primary recommendations for transferring a patient using the ABC (Airway, Breathing, Circulation) SBAR (Situation, Background, Assessment, Recommendation) (ATLS - Advanced Trauma Life Support) system?

ABC-SBAR Transfer System in ATLS Context

The ABC-SBAR transfer system combines the systematic ATLS primary survey approach (Airway, Breathing, Circulation) with structured SBAR communication (Situation, Background, Assessment, Recommendation) to ensure both physiological stabilization and effective information handoff during critical patient transfers. 1, 2

Pre-Transfer Stabilization: The ABC Approach

Airway Management

• Establish definitive airway control before transfer - tracheal intubation during transport is extremely difficult and should be avoided 1
• Senior clinician input is required when intubation necessity is uncertain 1
• Appropriate respiratory function must be confirmed before departure 1

Breathing Optimization

• Target PaO₂ ≥ 13 kPa while avoiding hyperoxia (particularly critical in acute ischemic stroke) 1
• Maintain PaCO₂ between 4.5-5.0 kPa 1
• Portable mechanical ventilator with airway pressure monitoring, minute volume monitor, and disconnect alarm must accompany the patient 1
• Calculate oxygen requirements including unforeseen delays and ventilator driving gas needs 1

Circulation Stabilization

• Ensure adequate blood pressure before transfer - systolic BP >110 mmHg for traumatic brain injury (MAP >90 mmHg) 1
• Invasive arterial blood pressure monitoring is preferable, though urgent transfer should not be delayed for arterial line insertion 1
• Have vasoactive drugs immediately available (ephedrine, metaraminol, noradrenaline, labetalol) 1

Essential Monitoring During Transfer

Continuous monitoring must match the standard provided in the referring unit 1:

• Glasgow Coma Scale with pupillary size and light reaction 1
• ECG and pulse oximetry 1
• Capnography (mandatory for intubated patients) 1
• Blood pressure (arterial line preferred, NIBP acceptable) 1
• Urine output via urinary catheter 1

SBAR Communication Structure

Situation (Prioritize Critical Information First)

• State the reason for emergency transfer immediately - ABC-SBAR training increases this prioritization from 4% to 81% of handoffs 2
• Communicate airway/breathing status within first 5 seconds of handoff 2
• Inform ambulance dispatcher this is a "life-threatening emergency" 1

Background

• Mechanism of injury or stroke type 3
• Time of onset and interventions performed 3
• Relevant past medical history affecting transfer 3

Assessment

• Current physiological parameters (ABC status) 2
• Neurological examination findings 1
• Response to interventions 3

Recommendation

• Specific receiving facility capabilities needed 3
• Anticipated interventions required 3
• Time-sensitive treatment windows 3

Required Equipment and Drugs

All equipment must be dedicated for transfers, regularly serviced, and checked immediately before departure 1:

Critical Medications

• Hypnotics (propofol or midazolam) 1
• Neuromuscular blocking agents (suxamethonium, atracurium, rocuronium) 1
• Opioid analgesics (alfentanil, fentanyl, remifentanil) 1
• Anticonvulsants (benzodiazepine, thiopentone, levetiracetam) 1
• Osmotic agents (mannitol 20% or hypertonic saline) 1
• Resuscitation drugs 1
• Cross-matched blood for trauma patients 1

Equipment Verification

• Check ambulance ventilator, oxygen supply, suction apparatus, and battery status before departure 1
• Ensure equipment compatibility with ambulance oxygen and power supply 1
• Store equipment in sealed containers indicating when restocking is needed 1

Training Requirements

All transfer team members must complete training in ATLS principles and transfer medicine 1:

• ATLS or European Trauma Course certification 1
• Adverse physiological changes during patient movement 1
• Practical aspects of ambulance/aircraft work 1
• Equipment and drug knowledge specific to transfers 1
• Communication and team-working skills 1

Common Pitfalls to Avoid

• Never attempt tracheal intubation during transfer - this must be completed before departure 1
• Avoid delaying urgent transfer for arterial line insertion when NIBP is adequate 1
• Do not underestimate oxygen requirements - calculate for delays and ventilator consumption 1
• Prevent communication breakdown by using structured ABC-SBAR format rather than unstructured handoffs that delay or omit critical information 2
• Ensure senior medical staff at both referring and receiving facilities make transfer decisions jointly 1
• Verify all portable equipment batteries are charged - they have shorter life expectancy than static equipment 1

Evidence Quality Note

The ABC approach represents ATLS consensus for priority-based assessment 1, 4, while SBAR implementation shows moderate evidence for improved patient safety, particularly in telephone communications 3. The combined ABC-SBAR approach demonstrates significant improvement in simulated critical handoffs, increasing essential information inclusion from 35% to 85% 2. However, adherence to systematic approaches varies widely (18-84% in clinical practice) 5, emphasizing the need for ongoing training and team leader presence 5.