Lessons from ICU-IS-SIM 002
Reviewed and revised 6 Feb 2017
Author: Chris Nickson
Reviewer: David Pilcher
Here are some top tips from the transport simulations sessions held at the Alfred ICU:
- transport is a vulnerable time for any critically ill patient. If in doubt, get help.
- preparation is everything. Anticipate and prepare for the worst.
- communication is also everything! Ensure appropriate role allocation, that everyone knows the plan, use closed loop communication and…
- always use the transport checklist. Do this using call-and-response. This ensures that all the staff involved in the transport know the plan and that nothing is missed. In the absence of a checklist Dave Pilcher likes to use an obscure mnemonic, DILTOS: drugs, information, lines, tubes, oxygen and space (will you fit! Is the destination ready?) – you might want to rearrange it as the “DO LIST”.
- the transport packs are streamlined to only have what is essential – at The Alfred ICU, if there is trouble during a transport a code should be activated and expert assistance will arrive rapidly.
- simplify what you need before you go – if you can safely stop a therapy or monitoring before you go, then do so.
- know which lines and ports you can use if you need to.
- be ready for common issues: monitoring failures, disconnections and dislodgements (especially lines and tubes), issues with positioning, communication failures, desedation and agitation, failure of drugs and equipment and delays (see Hofstadter’s law).
- Hold onto the endotracheal tube (and central lines) during transfers!
- Watch drip stands like a hawk – they are out to get you…
- in addition to Murphy’s law (anything that can go wrong, will), remember Hofstadter’s law (everything takes longer than you think, even if you take into account Hofstadter’s law).
- The CICM policy is essential reading for trainees: IC-10 Guidelines for Transport of Critically Ill Patients. It is a joint policy with ACEM and ANZCA, so emergency medicine and anaesthesia trainees need to know it too!
Check out this Orientation to the Oxylog 3000 for a brief introductory video and the Alfred ICU set up guide.
Finally Todd Fraser from Crit-IQ gives a useful introduction to patient transport of the critically ill in this video lecture: