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- The objective of critical care transport is to provide an equivalent or higher degree of monitoring and medical care than the patient was receiving prior to transport.
- Each contemplated transport requires an evaluation of the risks and benefits of the transport.
- The risks to the patient during interhospital and intrahospital transport can be minimized through careful planning, use of appropriately qualified personnel, selection of appropriate transport equipment, and proper patient evaluation and stabilization.
- For interfacility transport, the referring physician is responsible for the transport-related decisions. It is common and appropriate for the receiving physician or critical care transport specialist to make recommendations regarding the mode of transport or need for specialty personnel or equipment.
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In recent years, advances in bedside capabilities, diagnostics, and therapeutic interventions have dramatically improved care for critically ill and injured patients. In addition, comprehensive critical care units are no longer limited to academic and urban tertiary care centers, and have expanded to other clinical settings in suburban and rural areas. Despite these advances, the movement of critical patients may still be required for optimal patient care.
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Transport of critically ill patients may be divided into two categories: transport within the hospital (intrahospital) and transport between hospitals (interhospital). Despite the evolution in the bedside management of critical patients, it is anticipated that the number of critical patients who will need to be moved from one location to another will not diminish. Patients in outlying hospitals will need to be transferred to critical care centers, and patients in critical care units may require transfer to intermediate or special care units. Also, with continued advances in medical technology, it is expected that more critically ill patients will require transport for sophisticated diagnostic studies and therapeutic interventions, such as magnetic resonance imaging (MRI), computed tomography (CT), nuclear medicine imaging, angiography, and gastrointestinal contrast studies.
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From a historical perspective, the United States government began to pay a great deal of attention to highway-related accidents and fatalities with the passage of the 1966 National Highway Safety Act. By the early 1970s, civilian medical helicopters were being used in the prehospital transport of trauma victims and in the interhospital transport of critically ill and injured patients.
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In contrast, despite these advances in prehospital and interhospital transport, very little attention had been paid to the transport of patients within a facility. Intrahospital transports of critically ill patients are more likely to occur and require the same comprehensive and systematic approach as the interfacility transports.
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The focus of this chapter is on the transport of the critically ill or injured patient. These transports can originate from a number of locations that include the various intensive care units, the emergency department (ED), the operating room (OR), and so forth. Patients may go into the operating room with nothing more than a peripheral IV, but leave the OR intubated, with chest tubes, an arterial line, and various drainage tubes. ...