Transport of the critically ill

Safe transport of the critically ill patient requires accurate assessment and stabilisation of the patient before transport.  The critically ill patient has limited physiologic reserves, and the risk of adverse events during transport is high. Transport should only occur when absolutely necessary, i.e.:

• For investigations/interventions that will materially aid diagnosis or management

• To other hospitals that can offer an equal or better level of care.

During transport the patient should receive a level of care equal or better to the care they were receiving prior to transport.

Intra-hospital transport vs inter-hospital transport

All intubated patients (and most other ICU patients) will require both a doctor and nurse escort. Patients who are not intubated may also require a medical escort but this should be decided on a case by case basis.

Intra-hospital transport refers to the movement of patients within a single healthcare facility. It may involve a significant distance and time. This includes the transport of patients to an operating theatre or for investigations such as CT scan or MRI.

Inter-hospital transport refers to transport to another facility for diagnostic procedures or to access services that are situated in another location. This includes spinal patients and burns patients who may be transferred to Middlemore Hospital. During inter-hospital transport there is less immediate assistance available than during intra-hospital transfers.

The decision to transfer the patient is based on the benefits of care available at another facility against the potential risks involved. The need to transfer a patient should take into account the potential benefit on the management or outcome.

Planning to transport a patient

Coordination and communication:

• Inform your colleagues that you are on a transport, and ensure sufficient cover for resuscitation calls in your absence.

• Ensure that the patient’s family (and the patient, if conscious) are aware of the rationale for transport.  

• Referrals to other intensive care units must be made at a consultant to consultant level.  Ensure you know the name of the consultant and service that has accepted the patient, and their destination.

Pre transport procedures

Ideally you should not need to perform any procedure during a transport.  Intubation, chest tube insertion and cannulation should be performed prior to transport.

Monitoring, equipment and drugs

• Familiarise yourself with the contents of the transport pack.  This contains a range of airways fluids and cannulae that you may require on a transport. 

• The range of drugs you take should include all drugs necessary to manage acute life-threatening medical emergencies and those specific to the patient’s clinical condition.

• All patients undergoing transport should receive the same monitoring during transport as they had in the intensive care unit.  This includes as a minimum:

Respiratory

• End tidal CO_2.

• Pulse oximetry.

• Transport ventilator and oxygen supply.

• Bag mask ventilator.

• Portable suction.

Cardiovascular 

• ECG.

• Non-invasive blood pressure monitoring.

  • Ensure cuff in situ before transport in case of arterial line problems.

• Invasive blood pressure monitoring.

• 2 reliable IV lines.

  • Ensure they are well secured.  It may be impossible to replace a dislodged line during a transport.

Neurology

• Sedation infusions.

• Paralysing agents.

• 4 molar NaCl +/- mannitol for neurosurgical patients.