28. ICU Transport

Weigh risks versus benefits of transferring critically ill patients (higher level of care at another facility, need for a clinical study/test, operating room, etc.)

Communication prior to transfer from all teams involved in medical care

Appropriate trained personnel as part of transport team

Appropriate equipment

Continue use of appropriate monitoring

Consider environmental factors

Intrahospital transport: moving a patient from a stationary point within a hospital to another location within that same hospital (radiologic suite, procedural suite, operating room, ER to ICU, etc.)

Interhospital transport: moving a patient from a stationary point within a hospital to another separate hospital (by ground/ambulance, or air/flight)

Common Themes to Remember

Pretransport coordination and communication

Skilled accompanying personnel

Appropriate level of equipment

Monitoring during transport

Be prepared for mishaps (patient deterioration, equipment failure, etc.)

Key Pathophysiology

Increased risk of morbidity and mortality with any transport

Cardiopulmonary instability associated with changes in arterial blood gases is common when ventilated, critically ill patients are transported.

Greater proportion of secondary insults occur post transport in head-injured patients.

Trauma, burn, and spinal injury patients have a morbidity and mortality benefit when they are transferred to a tertiary care center.

Communication problems, inadequate protocols, in-servicing/training and equipment failure are prominent causes of transport-related incidents.

Patients are at increased risk for hypothermia when transported to remote locations.

Legal aspects and decision to transfer

Emergency Medical Treatment and Active Labor Act of 1986 (EMTALA)

Hospitals must provide an appropriate medical examination to determine whether or not an emergency medical condition exists

In the case of a deemed emergency medical condition, the hospital must stabilize the medical condition, as best able prior to transferring or discharging the patient

Determining need of transfer of the patient

Emergency medical condition has been stabilized and the patient requires a higher level of care.

The emergency medical condition has not been stabilized, but the treating physician certifies that the benefit of transfer outweighs the risk.

The patient or healthcare proxy requests transfer regardless of whether the emergency medical condition has been stabilized.

The on-call physician fails or refuses to appear within a reasonable period of time, and without the services of the on-call physician, the benefit of transfer outweighs the risk.