The transport team should make every effort to speak with the patient’s family before leaving the referring facility. This interaction may be as simple as an introduction, such as “Hi, my name is Jane Doe, and I am the transport nurse who will be with your family member during the transport.” During this interaction, the team can assess the family. The team can then alert personnel at the receiving hospital’s social or pastoral service department if it appears that the family may need their assistance. The transport team can also take this opportunity to determine the family’s plans for traveling to the receiving hospital and get an estimate of their time en route. Family members should be notified of the transport vehicle’s intended destination, and they should be told where to report once they arrive at the receiving facility. If necessary, directions to the receiving hospital can be given to the family. Many transport programs provide individual maps for this purpose. When possible, the family should be provided with a specific individual name or place they may ask for when arriving at the receiving facility. The transport team can offer to contact the family via cell phone at the conclusion of the transport. This practice is particularly useful with pediatric patients to help alleviate parental anxiety.

The transport team may pause before leaving the institution to allow family members to say goodbye to the patient. This is especially important if the patient’s injuries are life threatening; in this case, the family may not have another opportunity to speak to the patient before he or she dies. In this author’s experience, the opportunity to say goodbye to the patient is greatly appreciated by the family. In most cases, depending on the severity of the patient’s injuries, the transport can be delayed for a few minutes without negative effects on the patient’s outcome. These simple interactions between the family and the transport team are invaluable in helping to alleviate the family’s stress.

Fultz and colleagues¹³ conducted a study to identify the information needs of family members regarding air medical transport. The information needs rated as very important by family members included what was wrong with the patient, why the patient had to be flown to another facility, and where the patient could be found at the receiving hospital. Box 38-1 lists important needs that most family members perceived as being unmet. ¹³ The results of this research are important no matter how the patient is transported. Transport programs should use this information as a guide when providing care to the family to better care for the needs of the patient’s family.

Information concerning the patient’s family members should be communicated to the receiving hospital to facilitate continuity of care. The social services department of the receiving hospital can be alerted to cases in which their services may be especially needed. Personnel at receiving hospitals want to know whether the family plans to travel to their hospital. Because large distances must sometimes be covered by ground, an estimated time of arrival is useful. Knowledge of the family’s plans can be helpful in case the patient’s condition deteriorates and consent to perform particular procedures is needed. The hospital may need to know the family’s wishes for treatment if the patient’s condition is life threatening. Organ procurement issues can be considered if the staff knows when and if the family intends to arrive. These issues are particularly important if the patient is a minor.

Family members frequently leave the referring facility as soon as the decision is made to transfer the patient, and they may arrive at the receiving hospital ahead of the patient. In this case, the referring nurse can notify the receiving hospital of the family’s departure for their facility. If the receiving hospital is aware of the family’s intended time of arrival, they can direct the family to the appropriate area in the hospital.

Family members frequently ask whether they can travel to the receiving facility with the patient. In this era, patients and families are more assertive in making their requests known to the medical community. Research continues to show that patients, families, and healthcare providers can benefit from family presence. ^1,2,21,22

The decision to transport a family member is based on multiple factors, some more important than others. The personal feelings of a team member should not interfere with a decision on what is best for the patient and family. The entire transport team should provide input, but safety should always be the overriding principle. In air medical transport, the pilot has the final word. Safety for the entire team is the primary factor on which to base this decision when concern exists about the possibility of family interference.

Other factors the team may take into consideration when deciding whether to transport members of the patient’s family are the patient’s age, the seriousness of the patient’s condition, other transportation available to the family, and the length of the transport time. Box 38-2 provides examples of inclusion and exclusion criteria for transport of family members.

Some transport vehicles, particularly air medical, are not capable of carrying an additional passenger because of performance factors or space limitations. Although the aircraft may have the capability of carrying extra passengers, some limitations, including engine power, effects of weather on equipment performance, and the amount of weight the aircraft can safely carry, determine whether an additional passenger can be brought aboard.

Parents often ask whether they can accompany their child on the transport. Determination of whether the presence of the family member will pose a problem during transport is important because of an inappropriate level of anxiety. All family members exhibit some anxiety, and thus, anxiety should not rule out the possibility of the person going on the transport. The determination must be made on the basis of whether inclusion of the family members will interrupt the transport team’s duties if they sit in the front or interfere with care to the patient if they sit in the back. It cannot be stressed enough that if transporting the family member in any way jeopardizes safety or care, the family member should not be transported.

The transport team may want to exclude the family from the transport when the weather is marginal. This factor can apply to either a ground or an air vehicle. Diversions or precautionary landings require extra concentration on the part of the pilot; thus, interference with flying can occur if the pilot has to explain what is happening or calm a worried passenger. Ground vehicle drivers need to be able to address their full concentration on roads that may be ice covered or if visibility is impaired by fog.

Once the determination to transport family members is made, they need a safety briefing by the pilot in an air medical vehicle or the driver in a ground vehicle. The family member should be directed to the transport vehicle for the briefing while the patient is being prepared for the transport; this gives the pilot or driver an appropriate amount of time to conduct the safety briefing. The extra passenger can be belted in the seat and be ready for departure. If this is done before the patient reaches the vehicle, the transport is not delayed.

Edgington⁸ conducted a survey of all air medical programs in North America to investigate whether family or friends are taken on transports. The results showed that 60% of the programs carried extra passengers. The helicopter programs that carried family members did not advertise that they did so, and they transported them on less than 5% of their transports. Extra passengers were taken more frequently on transports of children. Fixed-wing aircraft programs transported family members on 35% to 95% of their transports. One fixed-wing aircraft program located in the Midwest claimed to carry family members on almost every transport. A program located in the West indicated that offering to transport family members was important because their transferring sites were so remote that the family refused to consent to the transfer unless they were allowed to accompany the patient. ⁸

Forty percent of the programs surveyed did not transport family members. Box 38-3 summarizes the reasons that influenced the decision by these programs not to transport family members. Of the programs surveyed, the ones that carried extra passengers listed the benefits of transporting family members. Box 38-4 lists some of these benefits. Problems with the transfers were rare; only three problems were listed. On one transport, a child experienced respiratory arrest and the parent was asked to assist in ventilation. In the other two cases, the passengers experienced airsickness. One program in Oregon has a pretransport screening form to determine a prospective rider’s suitability for transport. The form included questions about whether the potential passenger had had “recent alcohol or drug consumption, inner ear problems, pregnancy, back or joint trouble, and recent blood donation or dental work.”⁸