You have been asked to retrieve a 40-year-old patient, intubated with COVID pneumonia, from a small regional ICU. The clinical condition has deteriorated in the last two days with worsening oxygenation.
a) Discuss the considerations for this patient with regards to preparation and planning, to ensure safe transport. (70% marks)
b) Outline the factors that will dictate the choice of transport including the advantages and disadvantages of each.
a) "Considerations for this patient with regards to preparation and planning" could mean a whole range of possible things. We do not have a college answer to help us guess what the examiners wanted. Instead, here is a list of possible things to "consider" while planning and preparing a retrieval:
b) Only three minutes of frantic scribbling was allocated to this part, which means the following "model answer" is much longer than what is possible. Everything was included here mainly in order to include the maximum range of different possible answers which might be generated by the readers in the course of their revision. Most of this was taken directly from this excellent summary by shakEM.co.nz
|Road transport by ambulance|
|Air transport by helicopter|
|Air transport by fixed wing aircraft|
ANZCA "Guidelines for Transport of Critically Ill Patients
CICM "Minimum Standards for Transport of Critically Ill Patients" (IC-10, 2010)
Milligan, J. E., et al. "The principles of aeromedical retrieval of the critically ill." Trends in Anaesthesia and Critical Care 1.1 (2011): 22-26.
Koppenberg, Joachim, and Kai Taeger. "Interhospital transport: transport of critically ill patients." Current Opinion in Anesthesiology 15.2 (2002): 211-215.