Transport of critically ill patients
BMJ 1999; 319 doi: https://doi.org/10.1136/bmj.319.7206.368 (Published 07 August 1999) Cite this as: BMJ 1999;319:368
- Peter G M Wallace,
- Saxon A Ridley
Intensive care patients are moved within hospital—for example, to the imaging department—or between hospitals for upgraded treatment or because of bed shortages We will concentrate on transport of adults between hospitals, but the principles are similar for transfers within hospitals.
Principles of safe transfer
Experienced staff
Appropriate equipment and vehicle
Full assessment and investigation
Extensive monitoring
Careful stabilisation of patient
Reassessment
Continuing care during transfer
Direct handover
Documentation and audit
Although the Intensive Care Society and the Association of Anaesthetists have recommended that retrieval teams are established in the United Kingdom, 90% of patients are accompanied by staff from the referring hospital. Over 10 000 intensive care patients are transferred annually in the United Kingdom, but most hospitals transfer fewer than 20 a year. Each hospital thus has little expertise and few people gain knowledge of transport medicine. Most patients are accompanied by on call anaesthetic trainees. Not only does this leave the base hospital with inadequate on call staff but accompanying doctors often have little experience.
Specially equipped ambulances are best for transferring patients
Dangers of transport
Intensive care patients have deranged physiology and require invasive monitoring and organ support. Furthermore, they tend to become unstable on movement. Transport vehicles are not conducive to active intervention and no help is available. Staff and patients are vulnerable to vehicular accidents and may be exposed to temperature and pressure changes.
Organisational structure
National and regional
Department of Health, purchasers, and specialist societies have responsibility for
Guidelines
Audit
Bed bureau
Funding
Regional retrieval teams
Hospital or trust
Consultant with overall responsibility for transfers including
Local guidelines, protocols, check lists
Coordination with neighbouring hospitals
Availability and maintenance of equipment
Nominated consultant for 24 hour decisions
Call out system for appropriate staff
Indemnity and insurance cover
Liaison with ambulance service concerning specification of vehicle and process of call out
Communication systems between units and during transfer
Education and training …