Emergency Management and Transfer - Cranial Cases - Acute Neurosurgical Consultation - Guidelines - Life or Limb Policy - Objectives

Oct 5, 2026

Emergency Management and Transfer - Cranial Cases outlines a patient-centered urgent and emergent transfer pathway across Ontario. It describes a neurosurgical patient flow from pre-hospital transport through emergency assessment, neurosurgical consultation, transfer to level-designated centres, and repatriation for post-surgical and non-acute care. It also summarizes the Acute Neurosurgical Consultation Guidelines, including their purpose for ED physicians and the CritiCall referral process, plus the Life or Limb Policy principles and stated objectives for emergent and potentially transferable cases.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages58

Reading Time2 h 26 min

AccessFree to download

Neurosurgical Patient Flow Model – Urgent/Emergent Cases

Neurosurgical Centres in Ontario

Provincial Neurosurgical and Spine Roster

Acute Neurosurgical Consultation Guidelines

Life or Limb Policy

Guiding Principles

Objectives

Emergent Transfer Goals

Non-neurosurgical Management Considerations

Emergency Management and Transfer Cranial Cases For questions please email [info@ccso.ca](info@ccso.ca) Neurosurgical Patient Flow Model – Urgent/Emergent Cases PNO system goals, and the principle of patient-centered care, apply across the continuum | 1
Patient is transported to the
hospital and cared for by a team of paramedics | 2
Patient arrives to the
emergency department | 3 Patient is assessed
by an emergency department physician | 4
Patient iscared for by a team of health professionals who consult with neurosurgeon via CritiCall Ontario | 5 Patient is transferred
to a
neurosurgical centre or remains at home hospital | 6
Patient is repatriated to his/her community hospital for postsurgical care | 7
Patient iscared for by a team of health
professionals prior to rehab/ community care | 8
Patient receives non-acute care (rehab, complex care or longterm care) or returns home (with or without home care assistance) | | --- | --- | --- | --- | --- | --- | --- | --- | Neurosurgical Centres in Ontario All neurosurgical centres have been designated as Level 2 or Level 3: | | Level 2 Neurosurgical Centre | Level 3 Neurosurgical Centre | | --- | --- | --- | | Services | May not provide certain neurosurgical services (i.e. coil embolization) | Provides all neurosurgical services | | Coverage | Generally do not provide 24/7/365 | Provide 24/7/365 coverage | Provincial Neurosurgical and Spine Roster, facilitated by CritiCall Ontario, creates access to neurosurgical services (consult, transfer) for non-neurosurgical sites: | Level 2 Centre | Level 3 Partner | | --- | --- | | Health Sciences North | Toronto Collaborative (SMH, SHSC, UHN) | | Kingston General Hospital | The Ottawa Hospital | | Thunder Bay Regional Health Sciences Centre | Hamilton Health Sciences | | Trillium Health Partners | Toronto Collaborative (SMH, SHSC, UHN) | | Windsor Regional Hospital | London Health Sciences Centre | | | Windsor Regional Hospital – Quellette Site | | Trillium Health Partners (Mississauga) | | The Ottawa Hospital | | --- | --- | --- | --- | --- | --- | | | London Health Sciences Centre | | Toronto Collaborative (SMH, SHSC, UHN) | | Health Sciences North | | | Hamilton Health Sciences Centre | | Kingston General Hospital | | Thunder Bay Regional Health Sciences Centre | 4 Acute Neurosurgical Consultation Guidelines • Developed by Dr. James Rutka, Dr. Sunjay Sharma, Dr. Michael Fehlings and Dr. Avery Nathens, in collaboration with Provincial Neurosurgery Ontario and distributed electronically in December 2013. • Purpose: a) Enables ED physicians to identify cases that require urgent or emergent transfer. b) Provides CritiCall’s number for emergency referral service. • Guidelines can be downloaded by accessing CritiCall’s website : [http://criticall.org/webconcepteur/web/criticall/](http://criticall.org/webconcepteur/web/criticall/) 5 6 Life or Limb Policy Guiding Principles: • The Life or Limb Policy is in effect when a patient is life or limb threatened and therapeutic options exist, which are needed within 4 hours • A patient’s life or limb threatening condition is a priority and the identification of beds is a secondary consideration • No patient with a life or limb threatening condition will be refused care • LHIN geographic boundaries will not limit a patient’s access to appropriate care in another LHIN • Repatriation within a best effort window of 48 hours once a patient is deemed medically stable and suitable for transfer is key to ensuring ongoing access for patients with life or limb threatening conditions • Consulting physician is to respond to pages from CritiCall Ontario regarding a provisional life or limb case within 10 minutes and will provide medical consultation to determine if the patient is life or limb threatened and recommend course of action (e.g. provide recommendations regarding management of life or limb patient to includ

FAQs

What is the urgent/emergent cranial patient transfer flow across the care continuum?

The model covers transport to hospital care by paramedics, arrival at the emergency department, physician assessment, consultation with neurosurgery (via CritiCall Ontario), transfer to a neurosurgical centre or remaining at the home hospital, then repatriation for post-surgical care and later non-acute services or home care.

How do Level 2 and Level 3 Ontario neurosurgical centres differ?

Level 2 centres may not provide certain neurosurgical services and generally do not offer 24/7/365 coverage, while Level 3 centres provide all neurosurgical services and provide 24/7/365 coverage.

What are the key purposes and elements of the Acute Neurosurgical Consultation Guidelines?

The guidelines enable ED physicians to identify cases requiring urgent or emergent transfer and provide CritiCall’s number for emergency referral. They were developed in collaboration with Provincial Neurosurgery Ontario and distributed electronically in December 2013.

Oct 5, 2026

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