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It’s time we talked about transport of the critically ill

Ever stopped at the scene of an accident on a dark night? Treated a heart attack on a remote island? Coordinated the transfer of a critically ill baby with a heart defect?

Were you prepared? Did you have the right toolkit? You need a cool head to perform critical clinical interventions while simultaneously planning the transfer to definitive care.

Almost all patients have a transport phase: whether it’s from the scene of an accident to the hospital (pre-hospital care) or from a small health facility to a larger one (inter-hospital transfer.) It may follow a mass casualty incident (civilian or military) or a serious illness or injury overseas (international retrieval). Transport phases may arise from problems during pregnancy and the neonatal period, through childhood and risk-taking adolescence, to old age and complex multisystem disease. All these patients need skilled coordinated transport care.

While we may not all don a uniform and operate on the front line with emergency services or the military, transport care is everyone’s business. Bodies of water, desert, or mountains separate some patients from the medical facilities they require. At other times it is a stretch of road. Whether you are the isolated rural practitioner with a critically unwell child, a junior doctor phoning a trauma centre, a midwife, or nurse practitioner with an obstetric emergency, you are often unprepared and ill equipped for the transport phase.

Make sure you familiarize yourself with everything you have at your disposable. Image credit: Ambulans, inuti, Renault Master, Stockholm by Stefan Lindström
Make sure you familiarize yourself with everything you have at your disposal. Image: Ambulans, inuti, Renault Master, Stockholm by Stefan Lindström. CC BY-SA 3.0 via Wikimedia Commons.

You need to prepare the patient for transport. You need to anticipate the likely complications. You may have to accompany the patient by road, air, or sea—or wait to handover to a highly skilled transport team. You may be a member of that transport team, first day, new job. For the unaccustomed, critical care transport is scary. Whether you are just starting out in retrieval medicine or a seasoned veteran, here are ten top tips to always keep in mind.

  1. Look after yourself. Exercise, sleep, and keep museli/granola bars in every pocket. Shifts can be long and work is often intense. Breaks can be few and far between, so rest when you can. Stay hydrated.
  2. Get good with equipment. Examine everything. Push every button, twist every knob. Learn to troubleshoot alarms. You don’t want to be caught out by something while on call.
  3. Be obsessive about battery life, oxygen, and drugs. Take enough in case you are stranded somewhere for a few hours. Bad weather will do this.
  4. Be flexible. You need to be prepared to collect any patient with any disease at any time. You may be tasked to one job and diverted to another. Consider how you will manage multiple patients, and what compromises you can and cannot make.
  5. Use your cognitive simulator. Run through potential problems that may arise with your team while en-route. Be prepared for the worst.
  6. Practice your crew/crisis resource management skills. You will need them. Good communication and diplomacy are vital if you wish to succeed. Making it happen in austere environments is no walk in the park. Remember to thank the referring staff/emergency services at the scene and your team.
  7. Share the load. Discuss cases with colleagues and other professionals. Listen. Examine all solutions. Get feedback. Engage in active case review.
  8. Breathe. Too much adrenaline does not enhance performance. Develop strategies to calm the mind and steady the hand. Yoga and meditation help.
  9. Don’t become arrogant. Pride comes before a fall. Don’t wear your underpants on the outside of your flight suit.
  10. Smile. You have the best job in the world.

Featured Image Credit: Agusta A109K2 of Air – Transport Europe performing a medical evacuation in the western Tatra mountains in Slovakia by Tatransky. CC BY-SA 3.0 via Wikimedia Commons.

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