63: Transportation of the Critical Care Patient

INTRODUCTION

Moving a critical patient is a dangerous medical intervention. As with any medical intervention, there are risks and benefits. Over time, the risks have been mitigated by creation of specialized transport teams and equipment. The benefits still revolve around providing specialized treatments and diagnostics not available at every facility.¹ Recent literature has shown that time until definitive treatment is an important consideration. All these factors need to be taken into account by the physician when deciding when and how to transport critical patients.

Transporting critical care patients intrafacility or interfacility has some overlap. When moving a patient inside or outside of your facility, the patient needs to be packaged so that he or she is self-contained. All tubes (Foley, nasogastric, intravenous, and drainage), electronic equipment (monitors and pumps), and oxygen equipment must be secured to the patient or vehicle on which the patient is transported.² Equipment and medication to deal with anticipated changes in the event of failure of life-supporting machines must be carried with the transporting team. While transporting inside a facility might only require a small amount of supplies, the longer a transport is in time or distance, the larger the amount of supplies to carry.

When transporting a patient between facilities, there is a broad array of specialized teams and equipment necessary. The resources are designed to provide scene response, hospital-to-hospital transfers, or medical repatriation. The transport vehicle, skill of providers, and equipment carried in the vehicle vary depending on the mission. Identifying the most appropriate resource requires understanding of the different types.³ In addition, legal issues based around the Emergency Medical Treatment and Active Labor Act (EMTALA) need to be addressed prior to interfacility transfers.

Trauma was the first disease process to identify the benefits of moving critical patients to facilities that could provide definitive care. More recently, cardiac, stroke, and sepsis care have seen the benefits of getting critical patients to definitive treatment. All of these disease processes have realized the time-dependent need for highly specialized care. In many areas, emergency medical services (EMS) have developed systems to get the patients to the most appropriate facility, but sometimes this is not possible and the patients will have to be transferred from one facility to another.

HISTORY

The use of transportation resources to support the overall care of patients has a long-standing tradition. Organized movement of people with illnesses or injuries to higher levels of care began in the Napoleonic Era.⁴ As with many medical advances, military conflict has provided the impetus for improvement. During the US Civil War, under the leadership ...