A. Transport of critically ill patients occurs any time a patient is moved from one physical location to another. This may be from the field, intra- or interfacility, by any means of transportation (stretcher, ground-based ambulance, rotary-wing aircraft, fixed-wing aircraft).

1. Essentials.

a. Pretransport evaluation (whether the transport takes minutes or hours!).

i. All patient movement has inherent risks and should only be done if the benefits of transport are significant and outweigh the risks.

ii. Risks of patient movement increase with severity of illness and duration of transport time.

iii. Best managed with a thorough checklist and a systematic approach.

iv. There are no absolute contraindications to transporting the critically ill patient.

v. There are many factors that may make patient movement high risk.

vi. The level of patient care provided should not be compromised during the period of transport.

b. Monitoring.

i. Patients who require monitoring before transport require monitoring during transport.

ii. Requires care provider who

(a) Can interpret the information.

(b) Responds appropriately to changes in status.

2. Care provided.

a. For longer transport distances and longer time periods:

i. Same monitoring and care must be provided as in the intensive care unit (ICU) (dosing of routine medications, deep vein thrombosis [DVT], prophylaxis, nutrition, decubitus ulcer prevention, etc.).

b. Short intrafacility transports.

i. Bare minimum requirements for intrafacility transports are the ability to provide advanced cardiac life support (ACLS) response and emergency airway management.

3. Caution: Many recommendations for care of the critical patient during transport are anecdotal rather than evidence based.

A. To obtain necessary procedures or diagnostic tests (radiographic studies, operating room, angiography suite) that cannot be performed at the bedside or for which better quality will result if done in designated area rather than at bedside.

B. To transfer a patient to a facility that provides a higher level of care, services unavailable in the current facility, or in a critically ill, but stabilized, patient to allow for family proximity.

C. To remove a patient from a high-risk area (combat zone, fire, chemical spill, or disaster area).

1. Airway.

a. Secure endotracheal tube, and ensure that the tube will not be obstructed by patient activity or motion (bite block).

b. Consider delaying transport until 24 hours posttracheostomy.

c. Consider prophylactic intubation for even minimal respiratory instability.

2. Ventilation.

a. Familiarity with available transport ventilators is essential. Support from an experienced respiratory therapist is recommended. Transport ventilators exist that can match most, but not all, ICU ventilator modes.

b.

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