Safe transport of critically ill patients: Principles, protocols and best practices

Manjunath1, Gowtham2

1Nursing Supervisor, Kauvery Hospital, Marathahalli

2Nursing educator, Kauvery Hospital, Marathahalli

Abstract

Transporting critically ill patients is a high-risk but often unavoidable component of critical care. Whether within the hospital for diagnostic or therapeutic procedures or between facilities for advanced care, the process requires meticulous planning, skilled personnel, and specialized equipment. This report outlines the essential principles, equipment requirements, staff roles, and procedural steps for safely conducting intra- and inter-hospital transport of critically ill individuals.

Introduction

Critically ill patients are best managed within the secure environment of the Intensive Care Unit (ICU), where continuous monitoring, ventilatory support, and specialized nursing care are available. However, clinical scenarios such as the need for advanced imaging (CT, MRI), surgical interventions, or transfer to tertiary centers necessitate patient transport.

Transporting these patients outside the ICU setting involves significant risks due to the loss of environmental control and potential interruption in life-support systems. Therefore, ensuring patient safety during such transitions demands a structured approach involving preparation, assessment, monitoring, and coordination.

Types of Critical Care Transport

  • Intra-hospital Transport: From ICU to CT/MRI, Operating Theatre (OT), Cath Lab, etc.
  • Inter-hospital Transport: Transfer to higher-level care facilities or specialty hospitals.
  • Scene Run (Pre-hospital): From non-medical locations such as accident scenes to emergency facilities.

Each type carries its own set of logistical and clinical challenges but shares common risk factors including disconnection from support systems and reduced personnel availability.

Risks During Transport

  • Detachment from life-support and monitoring systems.
  • Equipment failure (e.g., oxygen depletion, battery loss).
  • Accidental extubation or IV line dislodgement.
  • Patient physiological deterioration (hypoxia, hypotension).

Key Principles

The A.C.C.E.P.T. Framework

An acronym to guide the critical stages of safe transport:

  • A – Assessment: Evaluate the patient’s overall stability and risk-benefit ratio of transport. Stabilize the patient beforehand; intubate if in doubt.
  • C – Control: Secure all IV lines, tubes, and airways. Confirm that all life-support equipment is functional.
  • C – Communication: Inform the receiving team. Maintain team communication during transit.
  • E – Evaluation: Monitor vital signs and intervene as needed. Continuously reassess patient’s clinical status.
  • P – Prepare & Package: Assemble essential equipment, documentation, and drugs. Assign experienced staff.
  • T – Transport: Move with care, maintaining all support systems. Document all events during transport.

Personnel Requirements

Minimum Two Trained Staff: Including one nurse and one critical care-trained physician for unstable patients.

Skills Required

  • Airway management
  • ACLS certification
  • ICU experience
  • Essential Equipment Checklist
  • Airway & Respiratory Support: AMBU bag, oxygen mask, suction device, LMA, Bain circuit, laryngoscope.
  • Monitoring Tools: ECG monitor, pulse oximeter, BP apparatus.
  • Vascular Access & Emergency Supplies: IV cannulas, syringes, crash cart medications.
  • Ventilation Considerations

For intubated patients:

  • Verify and secure ET tube.
  • Use portable ventilators if available.
  • Manual ventilation (AMBU) is common but less reliable for long-distance or precise settings.
  • Monitoring During Transport
  • Maintain continuous monitoring similar to ICU levels:
  • ECG, BP, pulse, respiratory rate, and oxygen saturation.
  • Ensure all equipment is battery-backed and fully charged.

Documentation

  • Thorough documentation is essential before, during, and after transport:
  • Pre-transport patient condition and interventions.
  • Ongoing monitoring data.
  • Post-transport evaluation and handover to the receiving team.
  • Adverse events, if any, for quality improvement review.
  • Common Adverse Events

1. Technical Mishaps

  • Disconnection of monitoring leads
  • Equipment battery failure
  • Accidental extubation or oxygen depletion

2. Physiological Deterioration

  • Worsening hypotension
  • Increased hypoxia

Conclusion

The transport of critically ill patients presents inherent risks but is often necessary for optimal care. A systematic, team-based approach grounded in preparation, vigilance, and communication can significantly mitigate these risks. Critical care nurses play a frontline role in ensuring patient safety, emphasizing the need for continuous training and adherence to transport protocols.

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