Safely transporting a critically ill patient requires a coordinated approach. The transport environment is hazardous. Travelling in the rear compartment of a road ambulance or aircraft is fraught with potential danger. Health and safety at work regulations have several specific provisions which are pertinent to the field of transfer medicine. This chapter focuses on safety in the transport environment in terms of: the team, the patient, the carers, the vehicle and equipment, and the organisation. If carers accompany the transport team it is important that they have appropriate clothing and footwear for all eventualities as described above for the staff. When travelling in the ambulance, family must always wear the seatbelt provided. It must be made clear that they must not release it unless the ambulance has come to a halt and the transport team and/or driver instruct them that it is safe to do so.
This chapter describes how to prepare the patient, equipment and personnel for transfer and explains the importance of a structured approach to the preparation and packaging of a patient for transfer. The acronym MINT (Medical, Instrumentation, Nursing, and Transportation) may be used to remind the team that 'preparation and packaging' does not only involve the physical preparation and continued treatment of the patient. Transportation is a reminder of whether the patient is to travel by cot, bed, incubator, hospital trolley or ambulance trolley. Before the transfer, the team leader must ensure that the patient is physiologically optimised and that all team members are fully briefed about the patient's needs. The key goal in packaging the patient is to achieve both physical security and accessibility. Physical and visible access to airway, breathing and circulation devices and equipment should be considered during packaging.
This chapter describes how the systematic ACCEPT approach enables movements of ill and injured patients between or within hospitals. Centralisation of specialist services means more transfers for clinical reasons. Many of these transfers will be time critical, some will be intensive, and some will be both. The chapter provides an overview of the patient groups that typically will need to be transferred to specialist centres, some of their characteristics and associated specific clinical management. Some of these broad categories of patients includes: neurosurgery (traumatic brain injury, cerebral bleeds), trauma, burns, vascular surgery (abdominal aortic aneurysm, thoracic aortic dissection, acute limb ischaemia), interventional radiology, cardiology (primary coronary intervention), nephrology (acute renal failure), obstetric, and level 3 transfers. However, early and effective communication between centres is essential to ensure that any specific treatments are administered before or during the transfer to optimise patient care.
This chapter contains sections titled: Air Transfers Applying the Accept Approach to Air Transfers Retrieval of Patients from Helicopters Fixed-Wing Air Transfers Summary
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