All transfers through the MAC are classified as “routine” or “urgent/emergent”.  The language with them really matters. MOST of our transfers are ROUTINE as long as it is not immediately life threatening (e.g. stable subdural hematoma), but routine transfers can sometimes take hours. If you have a transfer from the ED such as a head bleed, and the patient decompensates while the patient is waiting for a bed at LAC-USC, the transfer actually gets easier. You can upgrade the transfer to EMERGENT through MAC and they will get you in touch with the LAC-USC DEM attending who based on our agreement will accept the patient.
Similarly, for a CRITICAL neurosurgical patient, these transfers should be deemed EMERGENT with MAC and will be readily accepted attending to attending either by the neurosurgery attending or USC DEM attending regardless of bed status.
For a neurosurgical transfer not going smoothly, MAC is easily able to get the LAC-USC neurosurgery attending on the phone and you can have a magical attending to attending discussion. In our experience this usually results in a satisfactory result, and they do not mind being called.
Finally, we had a recent attempted neurosurgical transfer to UCLA. Unfortunately, ONLY ACUTE STROKE patients eligible for a mechanical thrombectomy by neurology will be accepted at UCLA from DHS hospitals.  Neurosurgery transfers should go through MAC to a county facility, unless they are out of plan (OOP), in which case we should try to transfer to someplace within their plan.
Approved by DEMs at<unk>  and LAC, LAC+USC Neurosurgery,<unk>  Medical Admin and MAC Feb 2018
If patient is OOP but stable, contact UR x74890 to attempt transfer within the patient's health plan
For unstable or DHS/uninsured patients, transfers will be made through the MAC to LAC+USC neurosurgery  (Harbor is no longer an option)
Indications for Potential Emergency Transfer:
ACUTE cerebral hemorrhages, including:
Subarachnoid hemorrhage (traumatic or spontaneous)
Intracerebral hemorrhage (ICH score >0)
Subdural or epidural hemorrhage
Any lesion with significant mass effect (e.g. midline shift >5mm, hydrocephalus, or increased ICP with risk or concern for herniation)
Acute or subacute spinal cord or cauda equine compression (e.g. abnl exam with sensory level, motor deficit, or MRI evidence of cord compression with CSF block or abnl cord signal)
Emergency Transfer may NOT be Indicated:
Mild traumatic brain injury (no or trace blood, no fracture, GCS ≥ 14 with stable scan)
Space occupying lesion with minimal mass effect: midline shift <5mm, no concern for herniation or increased ICP
Chronic mild spinal cord compression - no neurological deterioration without cord signal change or CSF block around cord
Chronic subdural hematoma (no acute blood products, size <7mm, no midline shift, no recent change in size if prior imaging available)
How to Transfer:
Contact LAC+USC Neurosurgery Resident to discuss case via MAC (866-940-4401); if no response, page resident directly through AMION (Logon = LACUSC)
If no response or disagreement with NS resident, Call LAC Neurosurgery Attending (Amion logon = LACUSC; if no response or disagreement with NS Attending, call Matt Waxman 310-497-7113 or Greg Moran 818-426-1478 or LAC Neurosurgery Service Chief Dr. Arun Amar (pager 213-508-0000) or the LAC CMO of the day via MAC
If no immediate neurosurgery intervention planned but needs monitoring in Neurocritical Care ICU, contact LAC+USC Neurocritical Care Attending (Gold Service) via MAC (866-940-4401)
If transfer is delayed, may initiate ED to ED transfer
If patient acutely demands urgent/emergent transfer but no DHS beds are available, page<unk>  CMO on-call @747-210-3000 to obtain approval for transfer to nearest trauma or comprehensive stroke center
Once transfer is accepted, call Utilization Management (UM) at 74890.  Notify them of the accepting facility and accepting physician.  UM will then take the lead in the transfer process.
How to Handle if Transfer maybe NOT indicated:
Contact LAC Neurosurgery via MAC (866-940-4401) to discuss patient's case
If no indication for emergent Neurosurgical intervention or ED to ED transfer, may call LAC+USC Neurology Gold Service or Medicine via MAC
If no indication for emergent transfer to LAC+USC Neurology or Medicine, may undergo initial evaluation and treatment at<unk> 
Re-evaluate transfer if imaging or condition worsens
ACUTE cerebral hemorrhages, including:
Subarachnoid hemorrhage (traumatic or spontaneous)
Intracerebral hemorrhage (ICH score >0)
Subdural or epidural hemorrhage
Any lesion with significant mass effect (e.g. midline shift >5mm, hydrocephalus, or increased ICP with risk or concern for herniation)
Acute or subacute spinal cord or cauda equine compression (e.g. abnl exam with sensory level, motor deficit, or MRI evidence of cord compression with CSF block or abnl cord signal)
Subarachnoid hemorrhage (traumatic or spontaneous)
Intracerebral hemorrhage (ICH score >0)
Subdural or epidural hemorrhage
Mild traumatic brain injury (no or trace blood, no fracture, GCS ≥ 14 with stable scan)
Space occupying lesion with minimal mass effect: midline shift <5mm, no concern for herniation or increased ICP
Chronic mild spinal cord compression - no neurological deterioration without cord signal change or CSF block around cord
Chronic subdural hematoma (no acute blood products, size <7mm, no midline shift, no recent change in size if prior imaging available)
Contact LAC+USC Neurosurgery Resident to discuss case via MAC (866-940-4401); if no response, page resident directly through AMION (Logon = LACUSC)
If no response or disagreement with NS resident, Call LAC Neurosurgery Attending (Amion logon = LACUSC; if no response or disagreement with NS Attending, call Matt Waxman 310-497-7113 or Greg Moran 818-426-1478 or LAC Neurosurgery Service Chief Dr. Arun Amar (pager 213-508-0000) or the LAC CMO of the day via MAC
If no immediate neurosurgery intervention planned but needs monitoring in Neurocritical Care ICU, contact LAC+USC Neurocritical Care Attending (Gold Service) via MAC (866-940-4401)
If transfer is delayed, may initiate ED to ED transfer
If patient acutely demands urgent/emergent transfer but no DHS beds are available, page<unk>  CMO on-call @747-210-3000 to obtain approval for transfer to nearest trauma or comprehensive stroke center
Once transfer is accepted, call Utilization Management (UM) at 74890.  Notify them of the accepting facility and accepting physician.  UM will then take the lead in the transfer process.
Contact LAC Neurosurgery via MAC (866-940-4401) to discuss patient's case
If no indication for emergent Neurosurgical intervention or ED to ED transfer, may call LAC+USC Neurology Gold Service or Medicine via MAC
If no indication for emergent transfer to LAC+USC Neurology or Medicine, may undergo initial evaluation and treatment at<unk> 
Re-evaluate transfer if imaging or condition worsens
OVMC:ED
RRMC:ED
SCVMC:ED
SCVMC:EXC
SCVMC:Main
MHH-TMC
Tdap
Harbor Macros: AMA