Inter hospital transfer of the critically ill patients
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This document provides guidelines for the inter-hospital transfer of critically ill patients. It outlines that transfers should only be done for appropriate clinical reasons by experienced clinicians using standardized protocols, equipment, and qualifications. Key risks of transport include technical complications and physiological deterioration that must be monitored closely during transit. Thorough planning of the transfer including indications, risks, equipment, staffing and transport conditions can help transfers be done safely. Continuous monitoring and documentation during all stages of the transfer process are emphasized.
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Transport of Critically Ill Patients
Guidelines for the inter- and intra-hospital transport of critically ill patients
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Recommended
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Volume 32(1), January 2004, pp 256-262
Intrahospital transport
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Transport of critically ill patient
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- 1. AAGBI 2009 European Society Of Intensive Care Medicine Inter hospital transfer of the critically ill patients Dr. Mesaros Daniel
- 2. Introduction • appropriate clinical reasons • difficult and potentially dangerous • appropriate personal, equipment, training and support
- 3. BACKGROUND • Recommendations • Indications • Risks • Planning the transfer • Conduct of the transfer
- 4. Recommendations • Transfer can be safely even in extremely ill patients • Decision must involve a senior and experienced clinician • Protocols, documentations and equipment should be standardized within networks • Appropriate competencies, qualifications and experience • Hospital must ensure: - suitable transfer equipment - adequate insurance cover - personal & equipment can safely return to base • Recorded and review
- 5. Indications • Technical and professional expertise: - neurosurgery - interventional radiology - percutaneous transluminal coronary angioplasty - continuous renal replacement therapy - organ transplantation - specific critical care interventions ( mechanical ventilation in prone postion) • Organizational aspects: - lack of available beds - massive influx of patients
- 6. Risks of transport • Technical complications – displacement of tubes, Intravascular lines • Pathophysiological deteriorations: - increased intracranial pressure - systemic hypotension/hypertension crisis - cardiac arrhytmias/arrest - drop in oxygenation saturation/airway obstruction • Additional movements: - acceleration/deceleration - tilting/lifting • Inadequate monitoring of cardiopulmonary function due to less advanced equipment/interference due to motion, etc…
- 7. Deciding/planning the transfer • Made by senior/consultant • Influenced by multiple factors: - course of disease (improvement/deterioration? - communication - staffing: medical, paramedical - logistics: equipment, resources - transport condition: distance, weather - modes of transportation: ambulance, helicopter, aircraft - handing over: documents, information - medico legal and ethical aspects
- 8. Transfer team • Specialized transport teams provide better care with decreased morbidity during and after transport • Two qualified personnel • Vehicle operator • Respiratory therapist
- 9. Transfer equipment • Airway management equipment • Medication • Electric devices • Trolley • Oxygen cylinder
- 10. Airway equipment
- 11. Airway management equipment • Resuscitation kit • Bag & mask • Oral airway • Laryngoscope & blade different sizes • ET tubes different sizes • Suction devices • Nebulizer • Adhesive tape
- 12. Oxygen cylinder
- 13. Electronic devices Monitors ECG Infusion pumps Invasive/noninvasive BP End-tidal capnography Temperature Pule oxymeter
- 14. Standard resuscitations drugs • Sedatives • Analgesics • Muscles relaxants • Inotropes
- 15. Trolley
- 16. Conduct the transfer • Check trolley and all equipment before and after each transfer • Preparing patient for transport: - secure intra venous access - airway stabilization - trauma victims – spinal mobilization - nasogastric tube - Foley’s catheterization - chest tube insertion - all drains - infusion pump & IV drips functioning properly - soft wrist and leg restraints - vital signs displayed on monitors - patient is safely secured on a trolley • Documentation
- 17. In transit procedure • Best route • Status of patient checked of intervals • Continuous monitoring
- 18. Arrival procedure • Assessment • Shifted • Complete handover • Documentation – patient status with time
- 19. Conclusions • Systematic approach • Careful planning • Benefits and risks should be weighed in every individual critically ill patient before transport • Anticipate the worst, think about possible complications and have a plan for how to react • With sufficient preparation and good equipment transfer is possible without an adverse event • Early communication will give you enough time to organize additional personnel & transfer itself • Proper use of personnel • Selection and availability of appropriate equipment
- 20. Thank you