Guidelines for Inter- and Intra-Hospital Transport of Critically Ill Patients

Transport of Critically Ill Patients from Sun YaiCheng

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

Intra-Hospital Transport

• Before transport, the receiving location confirms that it is ready to receive the patient for immediate procedure or testing.

• Documentation in the medical record includes the indications for transport and patient status throughout the time away from the unit of origin.

• 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.

• Equipment for airway management, sized appropriately for each patient, is also transported with each patient.

• For practical reasons, bag-valve ventilation is most commonly employed during intra-hospital transports.

Inter-Hospital Transport

• Once transfer decision has been made, the transfer is effected as soon as possible.

• Resuscitation and stabilization will begin before the transfer, realizing that complete stabilization may be possible only at the receiving facility.

• The informed consent process includes a discussion of the risks and benefits of transfer. These discussions are documented in the medical record before transfer. 

• A copy of the medical record, including a patient care summary and all relevant laboratory and radiographic studies, will accompany the patient.

• The preparation of records should not delay patient transport.

• It is recommended that a minimum of two people, in addition to the vehicle operators, accompany a critically ill patient during inter-hospital transport.

• When transporting unstable patients, the transport team leader should be a physician or nurse preferably with additional training in transport medicine. For critical but stable patients, the team leader may be a paramedic.

• These individuals provide the essential capabilities of advanced airway management, intravenous therapy, dysrhythmia interpretation and treatment, and BLS and ACLS.

• In the absence of a physician team member, there will be a mechanism by which the transport team can communicate with a command physician.

• Patient status and management during transport are recorded and filed in the patient medical record at the referring facility. Copies are provided to the receiving institution.

• Referring facilities will, before transport, begin appropriate evaluation and stabilization to the degree possible to ensure patient safety during transport.

• Non-essential testing and procedures will delay transfer and should be avoided. 

• A patient should not be transported before airway stabilization.

• If indicated, chest decompression with a chest tube is accomplished before transport.

• Medical record checklist should include documentation of initial medical evaluation and stabilization (to the degree possible), informed consent disclosing benefits and risks of transfer, medical indications for the transfer, and physician-to-physician communication with the names of the accepting physician and the receiving hospital.