1. TRANSPORT OF
CRITICALLY ILL

5. WHO
WHAT
WHERE
WHEN
WHY
SAFETY..SAFETY..SAFETY..

6. LEARNING OBJECTIVES
• PHYSIOLOGICAL IMPACTS OF
TRANSPORTATION
• TYPES OF TRANSFER
• ADVERSE EVENTS DURING TRANSPORTATION
• ORGANIZATION OF TRANSFER
• PREVENTION OF COMPLICATIONS

7. Dangers of transfers
1) Physiological changes:
Resp:
-decrease oxygenation
-Increase incidence of VAP 24% in transported pt vs
4.4% in non transported pt
Haemodynamics : Changes in HR, BP esp in post op pt
Neuro : increase ICP

8. )Hostile and unfamiliar environment
)Limited resources
)Equipment problems
)Technical complications
)Failure of continuity of care
)Crisis - e.g : hypotension/ hypertension/ arrythmias/ desatur

11. FREQUENCY AND NATURE
OF UNEXPECTED EVENTS

14. types of transfer
• Pre hospital
• Inter-hospital
• Intra-hospital

15. intrahospital transfer
• From emergency to wards
• From emergency to OT/ ICU
• From ward to OT/ICU
• From ward/ ICU to Radiology
• From ward / ICU to ward/ ICU

16. ORGANIZATION
OF
TRANSFER
cedures or tests outside the ICU is potentially hazardous, the

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

18. Assessment
Control
Communication
Evaluation
Prepare and package
Transport
Remember acronym…..

19. Assessment
• Initial assessment of the patient and situation as a
whole
• Indications - benefits must outweigh risks
• Stabilize before transport
• Anticipation of problem likely encountered en
route
• Degree of urgency to transfer

21. Stable to transfer??
• Refractory / Severe shock - High vasopressor/
inotrope -
• Hypoxemia - High ventilator settings/ FiO2 1.0 ?
• Secure airway when in doubt, borderline
indication -> intubation

22. control and communicate
• Communication - excellent communication within
team and receiving end
• Continuous assessment of effectiveness of
resuscitation and stabilisation process

23. • Experienced staff in intensive care or transfer
• Clear chain of responsibility

24. Prepare and package
• Preparation of patient, equipment, supplies,
accompanying medical and nursing personnel
• Sufficient supplies of drugs, fluids and oxygen
must be available to cope with extraordinary
delays
• Secure tubes, lines

26. equipments
* Equipment for airway management:
* -sized appropriately for each patient
* -oxygen source of ample supply to provide for
projected needs plus a 30-min reserve.
* Adequate battery back up

30. References

31. *Basic resuscitation drugs, including epinephrine
and anti-arrhythmic agents, are transported with
each patient in the event of sudden cardiac arrest
or arrhythmia.
*Supplemental medications, such as sedatives
and narcotic analgesics, are considered in each
specific case.

33. TRANSPORT

34. accompanying personal
* 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.

35. * Continuous BP monitor, pulse oximeter, and
cardiac monitor must accompany every patient
without exception.
* Alarms should be visible as well as audible in view
of extraneous noise levels
monitoring

36. documentation
• Clinical status before, during and after transfer
• patient condition - trend
• medicolegal implications
• proper handover referring -> transfer -> receiving
doctor
• in the end, evaluate process of transfer - for
quality improvement

37. Prevention of complications
• the necessity and safety for transport should be
assessed by multidisciplinary team
• risk of transport should be weighed against
potential benefits
• Use appropriate equipment, personal and
planning for each transport can minimise these
complications and ensure optimal benefit to
patients

38. • Risks can be diminished if patients are
appropriately selected and carefully monitored
during transportation
• In some cases, hazards of transporting a patient
could be prevented by performing diagnostic or
therapeutic procedures within ICU or choosing
alternative procedures that may render a transport
of the patient unnecessary.

39. • Avoid delay. Each 30 min delay can increase
mortality 300 times in severe injured patient.

40. TERIMA KASIH
•TERIMA KASIH