Patients who require services that<unk>  does not offer may need to be transferred out (e.g. neurosurgery, some emergent orthopedic cases).
For OOP patients who are clinically stable, every attempt should be made to transfer the patient to their health plan.
For uninsured or DHS-empaneled patients, transfer will occur through the MAC.
Transfers from the ED via the MAC fall into two categories. This is based on existing DHS policy:
(1) Emergent/Urgent e.g. intubated intracranial bleed. MAC will ask minimal questions in order to get transportation to<unk>  as quickly as possible.  CMO on-call (ask Operator)should be notified regarding emergent transfer.  Emergent/Urgent patients cannot be refused by Harbor or USC and may end up being transferred to their ED if no inpatient beds are available.  Emergent/Urgent transfers should be used on a rare basis for those patients who need to move RIGHT NOW aka emergently.
(2) Non-Urgent e.g. open tib/fib fracture or hip fracture. MAC will ask more detailed questions. Patients will be presented to appropriate service at USC or Harbor. Transportation will be arranged after patient has been accepted.
Remember both USC and Harbor have DHS Cerner and have access to our ED records and imaging
MAC will NOT transfer to private hospitals such as transfer of neuro patient to UCLA for intracerebral thrombolysis (exception burn cases) or pediatric patient who is followed by UCLA sub specialist at the<unk>  clinics. Transportation of those patients must be arranged by the private hospital or<unk>  UR.
(1) Emergent/Urgent e.g. intubated intracranial bleed. MAC will ask minimal questions in order to get transportation to<unk>  as quickly as possible.  CMO on-call (ask Operator)should be notified regarding emergent transfer.  Emergent/Urgent patients cannot be refused by Harbor or USC and may end up being transferred to their ED if no inpatient beds are available.  Emergent/Urgent transfers should be used on a rare basis for those patients who need to move RIGHT NOW aka emergently.
(2) Non-Urgent e.g. open tib/fib fracture or hip fracture. MAC will ask more detailed questions. Patients will be presented to appropriate service at USC or Harbor. Transportation will be arranged after patient has been accepted.
Remember both USC and Harbor have DHS Cerner and have access to our ED records and imaging
MAC will NOT transfer to private hospitals such as transfer of neuro patient to UCLA for intracerebral thrombolysis (exception burn cases) or pediatric patient who is followed by UCLA sub specialist at the<unk>  clinics. Transportation of those patients must be arranged by the private hospital or<unk>  UR.
BLS is staffed by EMTs, limited abilities, can administer oxygen;  cannot push meds and cannot have any hanging IV drips
ALS is staffed by paramedics, can take intubated patients, CANNOT take patients with ANY type of IV drip (no heparin, mannitol, norepi, etc) even if those drips are not titratable.  Drips must be shut off. ALS IS ABLE take maintenance IV with max of KCl 20meq/L.  ETA variable.
Critical care is staffed by paramedics plus Critical Care RN and/or MD, can take intubated patients with IV drips.   Often ETA of critical care team arrival 4-5 hours away.
Helicopter is staffed by paramedics +/- critical care RN, can take intubated patients with IV drips.   Dependent upon weather.   ETA variable.
For critically ill or injured patients on a drip that cannot be turned off, if critical care team's ETA is too long, consider sending<unk>  RN, MD and/or RT as needed in ambulance.  Arrange head of time for same ambulance to bring staff back to<unk> .
The Pediatric attending on-call should be made aware of any higher level of care transfer out
For OOP pediatric patients, UR should attempt to transfer the patient to the hospital requested by the health plan
For uninsured patients, not currently followed by a pediatric sub-specialist, attempts should be made to transfer to USC or Harbor via the MAC
Patients followed by UCLA Pediatric subspecialties at<unk>  may be transferred to UCLA if accepted by UCLA Pediatrics or subspecialist.<unk>  Pediatric resident will contact UCLA inpatient staff or subspecialty service about transfer with approval by the Pediatric attending on-call
Once accepted, transportation will depend upon the type of transfer:  PICU transfers may transported by the UCLA Transport team;  Ward transfers to UCLA will need to have transportation arranged by<unk>  UR staff.
MAC WILL NOT ARRANGE TRANSPORTATION TO UCLA<unk>  Pediatric resident will contact UCLA inpatient staff or subspecialty service about transfer with approval by the Pediatric attending on-call
Once accepted, transportation will depend upon the type of transfer:  PICU transfers may transported by the UCLA Transport team;  Ward transfers to UCLA will need to have transportation arranged by<unk>  UR staff.
MAC WILL NOT ARRANGE TRANSPORTATION TO UCLA
For all surgical and surgical subspecialties being transferred out for "higher level of care", please contact the Attending of that service prior to transfer out.  ED Attending should speak to Surgical Attending to ensure we do not have the ability to care for the patient here at<unk> 
See Neurosurgery
OVMC:ED
RRMC:ED
SCVMC:ED
SCVMC:EXC
SCVMC:Main
MHH-TMC
Tdap
Harbor Macros: AMA