Transport of Critically Ill Patients

Prepared by the Anaesthesia department of HKL

Introduction

Critically ill patients may have absent or small physiological reserves Adverse physiological changes during transport are common and can be life threatening Ventilator dependent and haemodynamically unstable patients are at particular risk 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

Summary

Equipment Staff Pre departure protocol In transit procedures At Destination protocol Documentation

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

Resource

Minimum Standard for Intrahospital Transport of Critically ill Patients ( Australian and New Zealand College of Anaesthetists)