Outline your principles of management in the transport of the critically ill patient.
Many candidates failed to mention guidelines, monitoring, handover or documentation.
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).
Justification for transfer
Interhospital transfer vehicle
CICM "Minimum Standards for Transport of Critically Ill Patients" (IC-10, 2010)