Transport of ICU Patients

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:

To learn more, check out the series of brief videos created by the Critical Care Network NW London: Transfer videos. (Hat tip to @Ganesh_ICM)

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