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KEY POINTS

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  • The transport of critically ill patients should be undertaken by appropriately trained and supported staff.

  • All critically ill patients undergoing transport are at risk of complications.

  • Preparation for transfer requires a systematic approach to assessment, physiological stabilization before departure, and communication between centers.

  • Adverse event recording and audit may improve the quality of transport systems.

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INTRODUCTION

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The transport of critically ill patients dates back to the Napoleonic wars, with Baron Dominique Larrey's invention of the “ambulance volante” to transport injured soldiers rapidly to the surgeon. In the modern era transport with ongoing intensive care support can be dated to Pantridge and Geddes' 1967 description in The Lancet of the successful transport of over 300 myocardial infarction patients to hospital by mobile intensive care unit with a high success rate for resuscitation.1

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Transport of critically ill patients is a common element in their care, encompassing journeys lasting from a few minutes to many hours. These may include transfer from the scene of injury or illness to the hospital, transport from the emergency department to the radiology department and the operating room, and from there to the intensive care unit. Transport across much greater distances may be necessary in rural areas, for tertiary referrals, and in repatriation from overseas for both civilian and military patients. The main determinants of risk common to all patient movements are dependence on organ system support, physiological instability and limited reserve, and separation from sophisticated diagnostic and therapeutic interventions.

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PRIOR TO TRANSFER

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Timing: Most transfers within the hospital occur at the convenience of the intensive care, imaging or operating room staff departments, and are contingent on the urgency of the intervention. Critical care transfers between hospitals can be classified as either time critical or nontime critical. An example of a time critical transfer would be that of an acute intracranial bleed requiring urgent neurosurgical intervention.2 Transfers outside working hours should be avoided if possible and, if aeromedical transfer is required, transfer during daylight hours is preferable. Duration of both intrahospital and interhospital transfers varies widely; dedicated transfer teams may reduce transfer times by reducing the time required for patient preparation.3

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Team Composition: To optimize efficiency and safety, a team leader should assume responsibility for patient preparation, communication between all relevant parties, and team coordination. The composition of the transfer team will depend on the requirements of the patient, specialist equipment in use, such as an intra-aortic balloon pump, and the duration and mode of travel. Team composition will also depend on local protocols, regional systems, and team member experience and training. A 2-year cohort study of 1169 patients transferred by air demonstrated no difference in outcomes between nurse-lead and physician-lead transfer teams.4 Indeed, nurse- or paramedic-lead teams may be appropriate for less severely ill patients regardless of the mode of transport.5 Longer distance ...

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