targeted to the transport of infants andchildren have been published by the American Academy of Pediatrics (23). In-stitutions performing commercial or or-ganized interhospital transports are re-quired to function at and meet a higherstandard, as the requirements for orga-nized transport services are considerablymore rigorous than the recommenda-tions in this guideline (24, 38
41).The references for this guideline wereobtained from a review of Index Medicus(see key words) from January 1986through October 2001 and are catego-rized according to the degree of evidence-based data employed. The speci
c cate-gory assigned to each reference is notedin the References at the end of this arti-cle. The letter
denotes a randomized,prospective controlled investigation;
denotes a nonrandomized, concurrent, orhistorical cohort investigation;
article,review article, editorial, or substantialcase series; and
denotes a non-peer-reviewed opinion such as a textbookstatement or of
cial organizational pub-lication. The asterisk symbol will follow astatement of practice standards. This in-dicates a recommendation by the Ameri-can College of Critical Care Medicine thatis based on expert opinion and is used incircumstances where published support-ing data are unavailable.
Because the transport of critically illpatients to procedures or tests outsidethe intensive care unit is potentially haz-ardous, the transport process must beorganized and ef
cient. To provide forthis, at least four concerns need to beaddressed through written intensive careunit policies and procedures: communi-cation, personnel, equipment, and moni-toring.
Pretransport Coordination and Com- munication.
When an alternate team at areceiving location will assume manage-ment responsibility for the patient afterarrival, continuity of patient care will beensured by physician-to-physician and/ornurse-to-nurse communication to reviewpatient condition and the treatment planin operation. This communication occurseach time patient care responsibility istransferred. Before transport, the receiv-ing location con
rms that it is ready toreceive the patient for immediate proce-dure or testing. Other members of thehealthcare team (e.g., respiratory ther-apy, hospital security) then are noti
ed asto the timing of the transport and theequipment support that will be needed.The responsible physician is made awareof the transport. Documentation in themedical record includes the indicationsfor transport and patient status through-out the time away from the unit of origin.
It isstrongly recommended that a minimum of two people accompany a critically ill pa-tient.* One of the accompanying personnelis usually a nurse who has completed acompetency-based orientation and has metpreviously described standards for criticalcare nurses (42, 43). Additional personnelmay include a respiratory therapist, regis-tered nurse, or critical care technician asneeded. It is strongly recommended that aphysician with training in airway manage-ment and advanced cardiac life support,and critical care training or equivalent, ac-companyunstablepatients.*Whenthepro-cedure is anticipated to be lengthy and thereceiving location is staffed by appropri-atelytrainedpersonnel, patientcaremaybetransferred to those individuals if accept-able to both parties. This allows for maxi-mum utilization of staff and resources. If care is not transferred, the transport per-sonnel will remain with the patient untilreturned to the intensive care unit.
A bloodpressure monitor (or standard bloodpressure cuff), pulse oximeter, and car-diac monitor/de
brillator accompany ev-ery patient without exception.* Whenavailable, a memory-capable monitor with the capacity for storing and repro-ducing patient bedside data will allow re- view of data collected during the proce-dure and transport. Equipment for airwaymanagement, sized appropriately foreach patient, is also transported witheach patient, as is an oxygen source of ample supply to provide for projectedneeds plus a 30-min reserve.Basic resuscitation drugs, includingepinephrine and antiarrhythmic agents,are transported with each patient in theevent of sudden cardiac arrest or arrhyth-mia. A more complete array of pharma-cologic agents either accompanies the ba-sic agents or is available from supplies(
) located along the trans-port route and at the receiving location.Supplemental medications, such as seda-tives and narcotic analgesics, are consid-ered in each speci
c case. An ample sup-ply of appropriate intravenous
uids andcontinuous drip medications (regulatedby battery-operated infusion pumps) isensured. All battery-operated equipmentis fully charged and capable of function-ing for the duration of the transport. If aphysician will not be accompanying thepatient during transport, protocols mustbe in place to permit the administrationof these medications and
uids by appro-priately trained personnel under emer-gency circumstances.In many hospitals, pediatric patientsshare diagnostic and procedural facilities with adult patients. Under these circum-stances, a complete set of pediatric resus-citation equipment and medications willaccompany infants and children duringtransport and also will be available in thediagnostic or procedure area.For practical reasons, bag-valve venti-lation is most commonly employed dur-ing intrahospital transports. Portable me-chanical ventilators are gainingincreasing popularity in this arena, asthey more reliably administer prescribedminute ventilation and desired oxygenconcentrations. In adults and children, adefault oxygen concentration of 100%generally is used. However, oxygen con-centration must be precisely regulatedfor neonates and for those patients withcongenital heart disease who have single ventricle physiology or are dependent ona right-to-left shunt to maintain systemicblood
ow. For patients requiring me-chanical ventilation, equipment is opti-mally available at the receiving locationcapable of delivering ventilatory supportequivalent to that being delivered at thepatient
s origin. In mechanically venti-lated patients, endotracheal tube positionis noted and secured before transport,and the adequacy of oxygenation and ven-tilation is recon
rmed. Occasionally pa-tients may require modes of ventilationor ventilator settings not reproducible atthe receiving location or during transpor-tation. Under these circumstances, theorigin location must trial alternatemodes of mechanical ventilation beforetransport to ensure acceptability and pa-tient stability with this therapy. If thepatient is incapable of being maintainedsafely with alternate therapy, the risksand bene
ts of transport are cautiouslyreexamined. If a transport ventilator is tobe employed, it must have alarms to in-dicate disconnection and excessively highairway pressures and must have a backupbattery power supply.*
Monitoring During Transport.
All crit-ically ill patients undergoing transportreceive the same level of basic physiologicmonitoring during transport as they had
257Crit Care Med 2004 Vol. 32, No. 1