This document provides guidelines for the transport of critically ill patients. It discusses the physiological impacts of transportation, including decreased oxygenation and increased risks of ventilation-associated pneumonia and changes in hemodynamics. It also notes risks from the unfamiliar transport environment and potential for equipment problems or discontinuity of care. The guidelines recommend assessing patient stability, controlling their condition, communicating between teams, properly preparing and packaging the patient and equipment, monitoring them during transport, and evaluating the process afterwards to minimize risks and ensure patient safety.

1. TRANSPORT OF
CRITICALLY ILL

5. WHO
WHAT
WHERE
WHEN
WHY
SAFETY..SAFETY..SAFETY..

6. LEARNING OBJECTIVES
• PHYSIOLOGICAL IMPACTS OF
TRANSPORTATION
• TYPES OF TRANSFER
• ADVERSE EVENTS DURING TRANSPORTATION
• ORGANIZATION OF TRANSFER
• PREVENTION OF COMPLICATIONS

7. Dangers of transfers
1) Physiological changes:
Resp:
-decrease oxygenation
-Increase incidence of VAP 24% in transported pt vs
4.4% in non transported pt
Haemodynamics : Changes in HR, BP esp in post op pt
Neuro : increase ICP

8. )Hostile and unfamiliar environment
)Limited resources
)Equipment problems
)Technical complications
)Failure of continuity of care
)Crisis - e.g : hypotension/ hypertension/ arrythmias/ desatur

11. FREQUENCY AND NATURE
OF UNEXPECTED EVENTS

14. types of transfer
• Pre hospital
• Inter-hospital
• Intra-hospital

15. intrahospital transfer
• From emergency to wards
• From emergency to OT/ ICU
• From ward to OT/ICU
• From ward/ ICU to Radiology
• From ward / ICU to ward/ ICU

16. ORGANIZATION
OF
TRANSFER
cedures or tests outside the ICU is potentially hazardous, the

17. Guidelines for the inter- and intra-hospital transport of
critically ill patients
Critical Care Medicine
Volume 32(1), January 2004, pp 256-262

18. Assessment
Control
Communication
Evaluation
Prepare and package
Transport
Remember acronym…..

19. Assessment
• Initial assessment of the patient and situation as a
whole
• Indications - benefits must outweigh risks
• Stabilize before transport
• Anticipation of problem likely encountered en
route
• Degree of urgency to transfer

21. Stable to transfer??
• Refractory / Severe shock - High vasopressor/
inotrope -
• Hypoxemia - High ventilator settings/ FiO2 1.0 ?
• Secure airway when in doubt, borderline
indication -> intubation

22. control and communicate
• Communication - excellent communication within
team and receiving end
• Continuous assessment of effectiveness of
resuscitation and stabilisation process

23. • Experienced staff in intensive care or transfer
• Clear chain of responsibility

24. Prepare and package
• Preparation of patient, equipment, supplies,
accompanying medical and nursing personnel
• Sufficient supplies of drugs, fluids and oxygen
must be available to cope with extraordinary
delays
• Secure tubes, lines

26. equipments
* Equipment for airway management:
* -sized appropriately for each patient
* -oxygen source of ample supply to provide for
projected needs plus a 30-min reserve.
* Adequate battery back up

30. References

31. *Basic resuscitation drugs, including epinephrine
and anti-arrhythmic agents, are transported with
each patient in the event of sudden cardiac arrest
or arrhythmia.
*Supplemental medications, such as sedatives
and narcotic analgesics, are considered in each
specific case.

33. TRANSPORT

34. accompanying personal
* It is strongly recommended that a minimum of
two people accompany a critically ill patient.
* It is strongly recommended that a physician with
training in airway management and ACLS, and
critical care training or equivalent, accompany
unstable patients.

35. * Continuous BP monitor, pulse oximeter, and
cardiac monitor must accompany every patient
without exception.
* Alarms should be visible as well as audible in view
of extraneous noise levels
monitoring

36. documentation
• Clinical status before, during and after transfer
• patient condition - trend
• medicolegal implications
• proper handover referring -> transfer -> receiving
doctor
• in the end, evaluate process of transfer - for
quality improvement

37. Prevention of complications
• the necessity and safety for transport should be
assessed by multidisciplinary team
• risk of transport should be weighed against
potential benefits
• Use appropriate equipment, personal and
planning for each transport can minimise these
complications and ensure optimal benefit to
patients

38. • Risks can be diminished if patients are
appropriately selected and carefully monitored
during transportation
• In some cases, hazards of transporting a patient
could be prevented by performing diagnostic or
therapeutic procedures within ICU or choosing
alternative procedures that may render a transport
of the patient unnecessary.

39. • Avoid delay. Each 30 min delay can increase
mortality 300 times in severe injured patient.

40. TERIMA KASIH
•TERIMA KASIH