Outline your principles of management in the transport of the critically ill patient.

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College Answer

Two inter-collegiate documents have been published (PS39 and IC-10) and cover the principles of management in detail.  Intra-hospital transport requires justification of transport (review of risks vs benefits), availability of appropriate and functional equipment (monitoring and emergency intervention), adequately skilled staff, appropriate pre-departure procedures (including checking of equipment and drugs, and accompanying patient records/investigations), planning of appropriate timing  and  route,  confirmation  of  appropriate  clinical  status  before  transport,  appropriate monitoring during transport, assessment of monitoring and equipment at destination, appropriate handover if another team assumes responsibility for care, appropriate documentation of clinical status during transport and some process to  facilitate quality assurance. Inter-hospital or pre- hospital transport also includes consideration of mode of transport (distance vs efficiency vs risks of road/fixed  wing/helicopter), and  potential  preventative procedures  before  transport  (e.g.  chest tubes).  For all transports, some forms of monitoring are considered mandatory (i.e. pulse oximetry, capnography [if mechanically ventilated], ECG, and blood pressure).

Discussion

This question is identical to Question 7 from the second paper of 2005.