2. INTRODUCTION
• A critically ill patient is defined as a patient who's at risk of life-treatening
event. This includes patients who are on various life support and also patients
who appears stable but are at risk of sudden deterioration
• Adverse physiologal changes (adverse event) during transport of the critically
ill patients are common and can be life-threatening
• Types of transport
1. Prehospital (non medical to a hospital)
2. Intrahospital (within a hospital)
3. Interhospital (hospital to hospital)
3. • Because the transport of critically ill patients is potentially hazardous, the
transport process must be organized and efficient.
• To provide for this, at least five concerns need to be addressed
• Remember "5P" :
1. Planning
2. Patient's condition
3. Packaging (equipment and monitoring)
4. Procedure
5. Pathway
4. "5P"
1. Patient's condition
- what case? Current condition? Latest plan?
- Key elements of stabilization prior to transfer (ABCDE)
- Some patients are too unstable- transport of the patient need to be aborted
7. "5P"
2. Planning
- Communications between personnels: Doctors, nurses, PPK
- Book bed/ transportation
- The receiving person or staff at the destination must be
notified, and the arrival time must be clearly understood.
8. "5P"
3. Packaging (equipments and monitor)
- Equipment should be appropriate for use according to the following factors:
a) Patient’s condition
b) Level of monitoring needed during transport
c) Level of therapeutic intervention required
- All equipment with good battery supply needs to be properly calibrated, maintained and regularly
checked
- Monitoring and infusion devices should be kept in areas visible to the accompanying staff.
- Always bring along equipments for intubation – for intubation or reintubation
13. "5P"
4. Procedure
- Suction ETT, mouth and aspirate NG tube before transfer,
- Cover patient properly – prevention of hypothermia, protect patient's privacy
14. "5P"
5. Pathway
- A best route should be planned
- Lifts should be secured or reserved beforehand
- The patient must be reassessed at all steps of movement during the transfer
16. COMMON PITFALL DURING TRANSFER
- Dislodgement or obstruction of endotracheal tube
- Patient agitation
- Accumulation of airway secretions
- Incorrect setting of ventilation parameters
- Oxygen supply failure
- Kinking of infusion lines
- Depletion of infusion drugs
- Failure of syringe pumps
- Failure of other portable equipment (e.g. monitors)
- Logistic issues, including beds not fitting into lifts or doorways, or being difficult to manoeuvre
- Hypo/hypertension
- Arrythmias
- Cardiac arrest
- Neurological deterioration
17. SOURCES AND REFERRALS
• Malaysian Society of Anaesthesiology - Inter Facility Transport of the Critically
Ill Patients
• Key elements of stabilization prior to transfer : Oxford Textbook of Critical
Care 2nd Edition
