I work in a five bed HDU(high dependancyunit )in a small rural hospital.Tends to make it interesting nursing...! We thrombolyse MI's, lots of multiole injuries, post ops, pre stent and CABG, some pediatric (not much thank goodness), multiple iv's (inotropes etc) od's, seizures , vents. Anyway, there is a point to this; we have had several patients in the last few months who could have benefited from being transferred to the tertiary hospital sooner rather than later, for diagnostics/treatment/assessment. For nurses, despite our best efforts, and our unit does really well for its patients I must say, we are finding it frustrating not being able to actually make the decision for transfer,hopefully before things deteriorate beyond recovery . We are therefore looking at setting up some guidelines and/or protocols to enable us to have some system in place for us to work by, e.g. multiorgan failure, multiple meds (esp. stuff like inotropes), which either arent working effecticely, multisystem involvement, longt-term ventilation ( more than 72 hours etc.)With MD involvement of course.Can any one help?Would be much appreciated.By the way, can take up to 21/2 hours to get the helicopter!!!