Clinical Review ABC of intensive care

Transport of critically ill patients

BMJ 1999; 319 doi: https://doi.org/10.1136/bmj.319.7206.368 (Published 07 August 1999) Cite this as: BMJ 1999;319:368
  1. Peter G M Wallace,
  2. Saxon A Ridley

    Intensive care patients are moved within hospital—for example, to the imaging department—or between hospitals for upgraded treatment or because of bed shortages We will concentrate on transport of adults between hospitals, but the principles are similar for transfers within hospitals.

    Principles of safe transfer

    • Experienced staff

    • Appropriate equipment and vehicle

    • Full assessment and investigation

    • Extensive monitoring

    • Careful stabilisation of patient

    • Reassessment

    • Continuing care during transfer

    • Direct handover

    • Documentation and audit

    Although the Intensive Care Society and the Association of Anaesthetists have recommended that retrieval teams are established in the United Kingdom, 90% of patients are accompanied by staff from the referring hospital. Over 10 000 intensive care patients are transferred annually in the United Kingdom, but most hospitals transfer fewer than 20 a year. Each hospital thus has little expertise and few people gain knowledge of transport medicine. Most patients are accompanied by on call anaesthetic trainees. Not only does this leave the base hospital with inadequate on call staff but accompanying doctors often have little experience.

    Specially equipped ambulances are best for transferring patients

    Dangers of transport

    Intensive care patients have deranged physiology and require invasive monitoring and organ support. Furthermore, they tend to become unstable on movement. Transport vehicles are not conducive to active intervention and no help is available. Staff and patients are vulnerable to vehicular accidents and may be exposed to temperature and pressure changes.

    Organisational structure

    National and regional

    Department of Health, purchasers, and specialist societies have responsibility for

    • Guidelines

    • Audit

    • Bed bureau

    • Funding

    • Regional retrieval teams

    Hospital or trust

    Consultant with overall responsibility for transfers including

    • Local guidelines, protocols, check lists

    • Coordination with neighbouring hospitals

    • Availability and maintenance of equipment

    • Nominated consultant for 24 hour decisions

    • Call out system for appropriate staff

    • Indemnity and insurance cover

    • Liaison with ambulance service concerning specification of vehicle and process of call out

    • Communication systems between units and during transfer

    • Education and training …

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