Transport of critically ill patient in hospital is a great task and requires, a well trained team and if not carried out with precision can lead to life threatening accidents..

1. Transport of Critically ill
Patients
Lt Col A K Singh
Classified Specialist Anaesthesiology
Dept of Anaesthesiology & Critical Care

2. Issues of intra-hospital transport
• Minimum Standards
for Intra-hospital .
• Transport of
Critically Ill Patients

3. 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.
• Careful planning is required to shift these pts in
hospital facilities such as
– operating theatres
– ICU,
– Emergency Department,
– imaging rooms,
– wards.

4. Intra-hospital transport is usually
–Elective,
– Emergency like to
the operating
theatres after a
diagnostic
procedure for
surgery.

5. 1. PROTOCOL
• Formulate hospital’s protocol of intra-hospital
transport of critically ill patients.
• Protocol widely known and available.
• The transport must be justified.
• Benefits of proposed interventions must
outweigh
– Risks of moving the critically ill patient
– Those posed by the interventions themselves.

6. EQUIPMENT
• Dedicated to intra- hospital transport.
• Durable, and trolley-linked devices .
• Able to enter lifts and pass through all
doorways en route.
• Able to function in the specific intervention
area
• (e.g. a magnetic resonance imaging room)
• Facilities for remote patient monitoring.
• Gas, suction, and electrical supplies at the
destination must be present and compatible.

7. EQUIPMENT
• Equipment should not be placed on the patient;
• Specially designed receptacles or transport
trolleys are useful.
• Basic monitoring
– ECG, heart rate,
– Blood pressure (by invasive or an automated non-
invasive monitor),
– Oxygen saturation by pulse oximetry
• Must be used for all patients.
• A capnometer must be used to monitor all
patients receiving mechanical ventilation.
• Defibrillator and a suctioning device must be
available.

8. EQUIPMENT
• A portable ventilator with a disconnect alarm is
required for ventilator dependent patients.
• Manual resuscitator bag must be available.
• PEEP and different modes of ventilation should be
available.
• Infusion pumps for accurate administration of drug
infusions.
• Alarms set with appropriate limits ,to detect any
hemodynamic instability.
• Fully charged, spare battery packs for electrically
driven devices.

9. –Equipment to secure the airway,
– Emergency drugs,
–Analgesics,
–Sedatives,
–Muscle relaxants.
• Ensure that all intra-hospital transport
equipment is readily accessible and
regularly checked.

10. STAFFING
• Key personnel for each transport event should be
identified.
• The transport team should consist at least of an
appropriately
– Qualified nurse,
– An orderly,
– Trained doctor.
• Each team must be familiar with the equipment and be
sufficiently experienced with
– Securing airways,
– Ventilation of the lungs,
– Resuscitation,
– Other anticipated emergency procedures.

11. PRE-DEPARTURE PROCEDURES
• The transport team must be freed from other
duties.
• The receiving person or staff at the
destination must be notified, and the arrival
time must be clearly understood.
• All pieces of equipment must be checked, and
notes and imaging films gathered.
• Individual responsibilities for checking
equipment must be defined.

12. Checklist .
• Monitors function,
• Alarm limits are set appropriately.
• Manual resuscitator bag functions properly.
• Ventilator (if used) functions properly;
• Respiratory variables and alarms are set
appropriately.
• Suction device functions properly.

13. Checklist
• Oxygen (± air) cylinders are full.
• Spare oxygen cylinder is available.
• Airway and intubation equipment are all
available and working.
• Emergency drugs, analgesics, sedatives, and
muscle relaxants are all available.

14. Checklist
• Additional drugs are made available if indicated.
• Spare IV fluids, inotropic solutions, or blood are
available.
• Spare batteries are available for all battery-
powered equipment.
• Chest tube clamps (if an underwater chest drain
is present) are available.
• Patient notes, imaging films, and necessary forms
(especially the informed consent form) are
available.

15. PATIENT STATUS
• Final preparation of the patient should be
made before the actual move,
• Conscious anticipation of clinical needs.
– appropriate doses of muscle relaxants or
sedatives,
– replacing near-empty
– inotropic and
– other IV solutions with fresh bags,
– emptying drainage bags.

16. PATIENT STATUS
• The patient must be reassessed before
transport begins, especially after
being placed on monitoring equipment and
the transport ventilator (if used).
• Transport preparations must not overshadow
or neglect the patient's fundamental care.
• An example of is listed below.
– Airway is secured and patent.

17. Brief check on the patient
– Airway is secured and patent.
– Ventilation is adequate; respiratory variables are
appropriate.
– All equipment alarms are switched on.
– Patient is haemodynamically stable.
– Vital signs are displayed on transport monitors
and are clearly visible to transport staff.

18. Brief check on the patient
–PEEP/CPAP (if set) and FIO2 levels are correct.
– All drains (urinary, wound, or underwater
seal) are functioning and secured.
–Underwater seal drain is not clamped.
– Venous access is adequate and patent.
– IV drips and infusion pumps are functioning
properly.
– Patient is safely secured on trolley.

19. IN-TRANSIT PROCEDURES
• A best route should be planned.
• Lifts should be secured or reserved beforehand.
• Adequate communication facilities during transit
and at the destination must be available.
• The status of the patient must be checked at
intervals, especially if the journey takes
considerable time.
• Any change in the patient's condition, unexpected
event, or critical incident, must be acted upon
immediately.

20. ARRIVAL PROCEDURES
On arrival at the
destination,
– receiving
– monitoring,
– ventilation,
– gas, suction,
– power facilities are
checked
– if the patient is to be
transferred from the
transport facilities.
•
Before shifting ensure.
– monitors,
– ventilators (if used),
– gas
– power supplies are
established.

21. • If another team assumes responsibility of
care, a complete hand over is given to the
team leader.
• The transport staff must remain with the
patient until the receiving team is fully ready
to take over care.

22. DOCUMENTATION
• The clinical record should document the
patient’s clinical status during transport until
handover occurs at the destination.
• He must record also after transport.

23. QUALITY ASSURANCE
The process of intra-hospital transport of
patients should be continually evaluated to
identify system problems and recommend
improvements.

24. THANK YOU