In austere circumstances, a functioning emergency medical system (EMS) may not exist or an existing system may not function as it should. In these circumstances, you may not be able to reach patients or they may not be able to get to you using normal methods (e.g., the roads are impassible). This chapter discusses improvised methods to transport patients or medical personnel.
The first question, however, is whether to transport the patient. In resource-poor settings, the decision whether to transport a patient is a delicate balance between patient benefit and the appropriate use of available resources. It comes down to asking two vital questions: CAN we transfer and SHOULD we transfer? The detailed parts of each question are listed in Table 20-1. All the parts must be answered "Yes" for a transfer to take place.
Table 20-1 Elements of Patient Transfer Decisions ||Download (.pdf)
Table 20-1 Elements of Patient Transfer Decisions
Can we transfer?
|Higher level of care (facility/equipment/skills) reasonably available (time/distance)||No higher level of care reasonably available|
|Referral facility accepts transfer||Referral facility refuses transfer|
|Transfer method available||Transfer method unavailable|
|Transfer safe for personnel||Unacceptable danger to personnel|
|Should we transfer?|
|Patient benefit probable||Patient benefit uncertain|
|Patient will probably survive transfer||Patient will probably die during transfer|
|Resources used for transfer not needed immediately by other patients and can be replaced before other patients need them||Other current patients need the resources to be used for transfer, or resources can't be replaced before needed by other patients|
|Patient/surrogate wants/accepts need for transfer||Patient/surrogate does not want/accept need for transfer|
If the patient has an IV in place, keep it flowing during transport: either put a pressure cuff (or blood pressure cuff or elastic bandage) around the bag or place the bag under the patient to maintain pressure and flow. The danger of this practice is not paying attention to the now-hidden IV bag, which results in letting the bag run dry, thus ruining the IV access port.
If the patient has an IV but doesn't currently need fluids—or needs them only intermittently—use a saline lock and put the IV fluids through it in boluses, as necessary. That also accommodates stopping the fluids and restarting them at a later time without having to restart an IV. Improvised saline (or heparin) locks are described in Chapter 5, Basic Equipment.
If a litter is not readily available or if one cannot be improvised, rescuers can choose from a variety of methods to transport patients, including carrying or dragging the patient. Evacuation from a multistory hospital is discussed later in this chapter.
Patients can be dragged head or feet first for short distances to remove them from a dangerous, time-critical situation or when they are in a confined space ...