Preparation of the critically ill for interhospital transfer

Abstract

SummaryChanges in monitoring and therapy during the preparation of 100 critically ill patients for interhospital transfer by a specialist team were documented prospectively with the aim of providing guidelines for nonspecialists. Severity of illness scores were recorded before and afrer preparation. Median duration of preparation for ambulance journeys was 50 min and for aeroplane journeys was 82 min. During preparation, a portable electrocardiogram and pulse oximeter were attached to 21 and 76 patients respectively and intra-arterial pressure monitoring was continued or instituted in 88 patients. Supplemental oxygen and intravenous ,fluids were the therapies most commonly increased or instituted by the transport team; mechanical ventilation, positive end-expiratory pressure and inotropic drugs were increased or instituted less frequently. Median therapeutic intervention scores before and after preparation were 21 and 23 respectively. highlighting the need to increase rather than withdraw support for transfer.

Incidence of complications in intrahospital transport of critically ill patients – experience in an Austrian university hospital

“…The concept of a careful equipment check and patient stabilization before transport has led to a lower incidence of physiologic deteriorations, as reported by Runcie et al in the setting of interhospital transports [17]. However, long-lasting stabilization before transport might not be feasible in emergency situations, and in such cases it is deemed to be an ongoing activity during transport.…”

The provision of sophisticated critical care beyond the hospital: Lessons from physiology and military experiences that apply to civil disaster medical response

“…For longer flights that include a larger number and variety of patients, the U.S. Air Force also has a recommended list of medications for in-flight use: Note that neither list provides for the routine availability of neuromuscularblocking (NMB) agents despite the fact that they are the most commonly administered medication during preparation for interhospital transfer (61). Because they induce apnea, these agents present risks for serious complications, and their use by inadequately trained personnel can be disastrous.…”

Comparison of teams is difficult

“…EDITOR,—Joseph Britto and colleagues' study of a paediatric retrieval team1 closely mirrors a descriptive study performed by the specialist transport team based in our hospital's adult intensive care unit 2. We agree with Stuart Logan, who says in his commentary on Britto and colleagues' paper that randomised controlled trials comparing specialist with non-specialist transfer are problematic and that evaluation of the introduction of specialist retrieval teams by the use of scoring systems should provide firmer evidence of their benefit 1.…”