Intrahospital transport is performed within the same hospital to different sites for diagnostic and therapeutic interventions. Interhospital transport involves the movement of a critically ill patient from one treatment facility to another.
Subsequent clinical management will be altered in approximately 40% of patients after transport out of the intensive care unit for diagnostic procedures and facilitated interventions. Abdominal computed tomography and angiography results are most likely to result in a change of management; thus transport is often well-justified.
Hemodynamic changes commonly encountered in transport include systemic hypertension, hypotension, and tachycardia. No clear factors predict hemodynamic deterioration during transport have been identified, except the level of overall pretransport morbidity, instability, or the presence of a recent myocardial infarction.
Respiratory deterioration including hypercarbia, hypocarbia, and hypoxemia may occur in a significant fraction of transported patients. Factors that predict changes include the need for positive end-expiratory pressure, an FiO2 greater than 50%, and age older than 43 years.
Appropriate assessment and management of the patient's airway is paramount in safe movement. Intubation during transport can be highly successful when performed by trained personnel, although patients with potentially difficult-to-manage airways are best intubated before transport.
Mechanical ventilation may maintain respiratory stability better than manual ventilation. Individuals trained in optimum manual ventilation (eg, respiratory therapists and anesthesiologists) and those with excellent patient assessment skills tend to maintain satisfactory respiratory parameters in patients undergoing transport. However, transport ventilatory systems may lack optimum alarms and may require constant surveillance for malfunction.
The US Emergency Medical Treatment and Active Labor Act (EMTALA, 1986) was established to mitigate financially motivated transport and requires that hospitals with emergency medical departments provide appropriate medical screening examinations within the capability of that hospital's emergency department, including ancillary services, to any individual who enters the department. If an acute medical condition is found, the department must either provide care or stabilize the patient before transfer to another facility.
Current regulations and good medical practice require that the competent patient or a legally authorized representative give informed consent before transfer to another hospital.
Physiologic monitoring of patients during transport should be maintained at the current level of care in the interest of patient's safety.
The advantages of air transport include reduced transport time over long distances and the ability to transfer many patients at one time. The primary disadvantages include a need for dedicated landing space, vibration, and expense. Potential insults related to transport by air include hypoxemia, decreases in ambient pressure, and hypothermia. "Altitude restrictions" are commonly ordered for patients with eye trauma, pneumothorax, intracerebral air, and sinusitis.
Pediatric patients (newborns and older children) are transferred most commonly for pulmonary insufficiency, cardiovascular compromise and congenital heart disease, or neurologic injury. This population benefits from dedicated specialty transport teams with specialized equipment.
Transport system design must involve integration of space, monitors, and support equipment that is compatible among the various sites to which a patient will be moved. Equipment engineering teams must design systems that minimize discontinuation of monitoring ...