Transportation of The Critically Ill Patient

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Transportation of The Critically Ill Patient
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• Equipment
• Accompanying Personnel
• Preparation for Transport
• Monitoring During Transport
• Management During Transport
• Documentation
• Supplementary Equipment For Use During Transport
• Is The Patient Stable For Transport?

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Equipment

• As much of the equipment as possible should be
  mounted at or below the level of the patient .
  In particular, large arrays of vertical drip
  stands should be avoided. This allows unhindered
  access to the patient and improves stability of
  the patients bed.
• Ideally all equipment within a transport should
  be standardized to enable the seamless transfer
  of patients without, for example, interruption of
  drug therapy or monitoring due to incompatibility
  of leads and transducers.

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• All equipment should be robust, durable and
  lightweight. Electrical equipment must be
  designed to function on battery when not plugged
  into the mains.
• Portable monitors should have a clear illuminated
  display and be capable of displaying EKG,
  arterial oxygen saturation, non-invasive and
  invasive blood pressure monitoring, capnography
  and temperature. Alarms should be visible as
  well as audible.

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• Additional equipment for maintaining and securing
  the airway, IV access, etc should also be
  available

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Accompanying Personnel

• The critically ill patient should be accompanied
  by a minimum of two attendants.
• One attendant should be a medical practitioner
  with appropriate training in intensive care
  medicine, anesthesia, or other acute specialty.
• He or she should be competent in resuscitation,
  airway care, ventilation and other organ support.
• The responsible medical practitioner should be
  accompanied by another suitably experienced
  nurse, and or technician.

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Preparation For Transport

• Prior to departure, transport attendant must
  familiarize himself with treatment already
  undertaken and independently assess the patients
  condition.
• In all cases, full clinical details must be
  obtained, for example, (vent settings, all
  current meds, latest ABG, CBC, Metabolic panel,
  CXR) before leaving the unit or OR.
• Meticulous resuscitation and stabilization of the
  patient before transport is the key to avoiding
  complications during the journey.

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• The airway should be assessed and if necessary
  secured and protected.
• Intubated patients should normally be paralyzed
  and sedated.
• If a PTX is present or likely, chest drains
  should be inserted prior to departure.
• Secure venous access is mandatory and at least
  two wide bore IV cannulae are required. An
  arterial line is ideal for BP monitoring.

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• Hypovolemic patients tolerate moving poorly and
  circulating volume should be near normal prior to
  transport. This may require loading with
  crystalloid, colloid or blood. If inotropes or
  other vasoactive agents are required to optimize
  hemodynamic status, patients should be stabilized
  on these before leaving the unit.
• Patients who are persistently hypotensive despite
  resuscitation efforts should not be moved until
  stable. Continuing sources of blood loss or
  sepsis should be identified and controlled.

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Monitoring During Transport

• The standard of care and monitoring during
  transport should be at least as good as it is in
  the unit.
• Minimum standards required for all patients are
  appropriate staff, EKG, BP monitoring and
  arterial oxygen saturation.
• ICP monitoring may be required in certain
  patients.
• A written record of pt status, monitored values,
  treatment given and any other clinically relevant
  information should be completed after transfer.

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Management During Transport

• All equipment must be securely stowed. Under no
  circumstances should equipment (e.g. infusion
  pump) be left on top of the patient. Gas
  cylinders must properly be placed at the foot of
  the bed or if necessary, under the bed.
• Monitoring must be continuous throughout the
  transport. All monitors and pumps should be
  visible to accompanying staff.
• Adequately resuscitated and stabilized patients
  should not normally require dramatic changes to
  treatment during transport.

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Documentation

• Clear records must be maintained of all stages.
  These should include details of the patients
  condition prior to and after transport, details
  of vital signs, clinical events and therapy given
  during transport.

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Supplementary Equipment

• LMA
• ETTs
• Laryngoscopes
• Intubating stylet
• Tape for securing ETT
• Stethoscope
• Self inflating bag and mask with oxygen reservoir
  and tubing

• Syringes
• Needles
• IV cannulae
• IV fluids
• Infusion sets/extensions

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Is The Patient Stable For Transport

• Airway
• Airway safe or secured by intubation
• Tracheal tube position confirmed on CXR

• Ventilation
• Paralyzed, sedated and ventilated
• Adequate gas exchange confirmed by ABG

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• Circulation
• HR, BP stable
• Tissue and organ perfusion adequate
• Any obvious blood loss controlled
• Circulating blood volume restored
• Hb adequate
• Minimum of 2 routes of venous access

• Neurology
• Seizures controlled, metabolic causes excluded
• Raised ICP appropriately managed

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• Trauma
• C-spine protected
• PTX drained
• Long bonel/pelvic fractures stabilized
• Intra-thoracic and intra-abdominal bleeding
  controlled

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