TRANSPORT OF

CRITICALLY ILL
PATIENTS
Presenter : Waazalimah Wahid
Supervisor : Dr Noorfidah binti Abdul Rashid
INTRODUCTION
• The safest place for the critically ill patient is stationary in the ICU
• There may be situations when the patient has to leave these
secure surroundings to be transported to the radiology
department, OT, other department within the hospital or other
hospitals.
• Adverse physiological changes during transport are common and
can be life threatening
 ventilator dependent (hypoxemia)
 hemodynamically unstable patients (hypotension)
• Any adverse events must be promptly attended to, often in
unfamiliar environment, limited room , equipment and personnel.
• As such the transport itself must be justified. Benefit of proposed
intervention must outweigh risk of moving such patients
TYPES OF TRANSPORT
INTER-HOSPITAL
INTRA-HOSPITAL
SUMMARY
• Equipment
• Staff
• Pre depature protocol
• In transit procedures
• At Destination protocol
• Documentation
REMEMBER ACRONYMACCEP
T
EQUIPMENT
• Ideally dedicated transport equipment, trolley linked devices that
must be able to enter lifts and pass through all doorways en route
• Monitoring- a minimum of ECG, BP monitoring and Pulse oxymetry
with properly set alarms
• A defibrillator and a suctioning device should be available
• For ventilator dependent patients a portable ventilator with a
disconnection alarm. Nonetheless a manual resuscitator bag must
be always available
• Oxygen tanks are full with spare ones if the journey is long
EQUIPMENT
• Equipment to secure airway as well as
emergency drugs
• All electrically driven devices must be
fully charged and spare battery packs
is highly recommended
• A check list for equipment before
transport is good practice
STAFF
• The transport team should be free from other duties
• Should consist of an appropriately trained doctor, a qualified nurse
and an attendant
• Each team member must be familiar with equipment and be
sufficiently experianced with securing airways, resuscitation and
other anticipated emergency procedures
PRE DEPATURE PROTOCOL
• You must have complete knowledge of the patients
history, diagnosis and his current treatment plan
• Ensure patients notes are complete and all consent for
the planned procedure if needed are up todate.
• Final check that equipment is working well
• Review patients status to ensure he is stable for the
planned transfer with adequate venous access.
• No equipment should rest on patient directly
PRE DEPATURE PROTOCOL
• Check that route is planned, lifts are available and waiting and the
destination is ready to receive the patient
• Final preparation of the patient should be made before the actual
move , with conscious anticipation of clinical needs( eg top up
sedatives and replacing near empty inotropes and emptying
drainage bags)
IN TRANSIT PROCEDURES
• Routine checking of patients status
• Monitoring must be visible to the doctor and nurse during transport
• Care must be taken that airway and lines are not under stretch
• Communication between staff during transport is essential
AT DESTINATION PROTOCOL
• Plug in all equipment into mains power
• If patient is to be transferred to another set of equipments at
destination, it should be checked before hand
• Full hand over to receiving staff
• The transport team should remain with the patient untill the
receiving team is fully ready to take over care
DOCUMENTATION
• Its good practice to document patients status during transfer ,
including all adverse events and drugs given .
SUMMARY
• Transfer of a critically ill patient should not be taken lightly
• Adverse events are common and are poorly tolerated by
these patients
• Attention to details is essential during transport
• Protocol driven transfers are highly recommended

1. Careful planning
2. Appropriately qualified personnel
3. Selection / availability of appropriate equipment

AVOID DELAY. EACH 30 MINS DELAY CAN INCREASE

MORTALITY 300 TIMES IN SEVERE INJURED
PATIENT.
RESOURCES
• Minimum Standard for Intrahospital Transport of Critically ill
Patients ( Australian and New Zealand College of Anesthetists)
• AAGBI 2009 ; European Society Of Intensive Care Medicine
• Transfer Times to Definitive Care Facilities Are Too Long, Ann
Surg. 2005 Jun; 241(6): 961–968
• Initial
Evaluation of the Trauma Patient, Apr 21, 2017. David J
Dries, MD, MSE, FACS, FCCP, FCCM, John Geibel, MD, MSc,
DSc, AGAF. https://emedicine.medscape.com/article/434707-
overview