A retrospective review of advanced life support interfacility transfers of the public sector emergency medical service in the Western Cape Province, South Africa.

Background: The need for critical care transfers (CCTs) has increased in recent years owing to the growing prevalence of high-acuity patients who require access to specialised care and/or resources that are not readily available at the facility where they find themselves. During their transfer from one facility to another, critically ill and injured patients commonly require ongoing care, monitoring and interventions that can only be provided by transfer teams with advanced training and appropriate equipment. In South Africa (SA), these transfers are undertaken mainly by advanced life support (ALS) providers with variable amounts of training. Understanding the demographics and needs of CCT patients in specific contexts is essential to inform training and policy. Objectives: To broadly describe the population of adult patients undergoing CCTs facilitated by the public sector emergency medical service (EMS) in the Western Cape Province, South Africa. Patient demographics (age and gender), time intervals (response time, scene time, transfer time), primary diagnosis (respiratory, cardiovascular, gastrointestinal tract, and others), attachments, and clinical or pharmacological interventions. Methods: A retrospective descriptive analysis was conducted on electronic patient care records (ePCRs) logged in the EMS's Computer-Aided Dispatch (CAD) database from January 2018 to December 2021. As no universal criteria currently exist for distinguishing a CCT from another transfer, our focus was on cases that required ALS care during the transfer. Results: During the study period, 25 635 adult patients underwent ALS transfers, with a nearly equal gender distribution. The median patient age was 40 (range 18 - 101) years. Sixty percent of patients were triaged as orange upon arrival (for urgent management) and the remainder red (for emergency or immediate management). Average response, preparation, and transport times spent (minutes:seconds) were 7:10, 16:58, and 12:56, respectively. Respiratory disease (17.9%), cardiovascular disease (12.2%), and central nervous system disorders (12.0%) were the most prevalent clinical conditions. Non-invasive blood pressure monitors (98%) and pulse oximeters (96%) were commonly used devices. Medications were administered to 22% of patients, primarily via intravenous injection (7.5%) and continuous infusion (6.7%). Morphine (4.3%), midazolam (6.4%), and adrenaline (2.0%) were frequently utilised medications. These findings highlight the demographic profile, clinical conditions, and critical care aspects involved in ALS patient transfers, emphasising the complexity and urgency of prehospital medical transport. Conclusion: This study analyses adult patients undergoing ALS transfers by a public sector EMS in the Western Cape, SA (2018 - 2021), providing insights into the transferred patient population. It highlights the importance of continuous patient monitoring, especially electrocardiograms (ECGs), and reveals inconsistencies in medication practices, indicating the need for improved training. The findings stress the necessity for standardised protocols and structured training programmes to inform educational initiatives, equipment procurement, and the critical care retrieval services (CCRS) curriculum development. Additionally, this research can help establish clinical standards for dispatching specific ALS cadres based on patient needs. Contribution of the study: This study provides the first large, system-wide description of 25 635 adult advanced life support (ALS) interfacility transfers in the Western Cape public emergency medical service (2018 - 2021), detailing patient profiles, monitoring, devices, and medications. By mapping real-world care patterns, especially gaps in electrocardiograph monitoring and analgesia/sedation for ventilated patients, it generates the empirical baseline needed to standardise protocols and formally develop a critical care retrieval services (CCRS) curriculum aligned to local needs. The findings also support evidence-based equipment planning and ALS cadre dispatch criteria.