1. AAGBI 2009
European Society Of Intensive Care Medicine
Inter hospital transfer of the
critically ill patients
Dr. Mesaros Daniel

2. Introduction
• appropriate clinical reasons
• difficult and potentially dangerous
• appropriate personal, equipment, training and
support

3. BACKGROUND
• Recommendations
• Indications
• Risks
• Planning the transfer
• Conduct of the transfer

4. Recommendations
• Transfer can be safely even in extremely ill patients
• Decision must involve a senior and experienced clinician
• Protocols, documentations and equipment should be
standardized within networks
• Appropriate competencies, qualifications and experience
• Hospital must ensure: - suitable transfer equipment
- adequate insurance cover
- personal & equipment can
safely return to base
• Recorded and review

5. Indications
• Technical and professional expertise:
- neurosurgery
- interventional radiology
- percutaneous transluminal coronary angioplasty
- continuous renal replacement therapy
- organ transplantation
- specific critical care interventions ( mechanical
ventilation in prone postion)
• Organizational aspects:
- lack of available beds
- massive influx of patients

6. Risks of transport
• Technical complications – displacement of tubes,
Intravascular lines
• Pathophysiological deteriorations:
- increased intracranial pressure
- systemic hypotension/hypertension crisis
- cardiac arrhytmias/arrest
- drop in oxygenation saturation/airway obstruction
• Additional movements: - acceleration/deceleration
- tilting/lifting
• Inadequate monitoring of cardiopulmonary function
due to less advanced equipment/interference due to
motion, etc…

7. Deciding/planning the transfer
• Made by senior/consultant
• Influenced by multiple factors:
- course of disease (improvement/deterioration?
- communication
- staffing: medical, paramedical
- logistics: equipment, resources
- transport condition: distance, weather
- modes of transportation: ambulance, helicopter, aircraft
- handing over: documents, information
- medico legal and ethical aspects

8. Transfer team
• Specialized transport teams provide better
care with decreased morbidity during and
after transport
• Two qualified personnel
• Vehicle operator
• Respiratory therapist

9. Transfer equipment
• Airway management equipment
• Medication
• Electric devices
• Trolley
• Oxygen cylinder

10. Airway equipment

11. Airway management equipment
• Resuscitation kit
• Bag & mask
• Oral airway
• Laryngoscope & blade different sizes
• ET tubes different sizes
• Suction devices
• Nebulizer
• Adhesive tape

12. Oxygen cylinder

13. Electronic devices
Monitors
ECG
Infusion pumps
Invasive/noninvasive
BP
End-tidal capnography
Temperature
Pule oxymeter

14. Standard resuscitations drugs
• Sedatives
• Analgesics
• Muscles relaxants
• Inotropes

15. Trolley

16. Conduct the transfer
• Check trolley and all equipment before and
after each transfer
• Preparing patient for transport:
- secure intra venous access
- airway stabilization
- trauma victims – spinal mobilization
- nasogastric tube
- Foley’s catheterization
- chest tube insertion
- all drains
- infusion pump & IV drips functioning properly
- soft wrist and leg restraints
- vital signs displayed on monitors
- patient is safely secured on a trolley
• Documentation

17. In transit procedure
• Best route
• Status of patient checked of intervals
• Continuous monitoring

18. Arrival procedure
• Assessment
• Shifted
• Complete handover
• Documentation – patient status with time

19. Conclusions
• Systematic approach
• Careful planning
• Benefits and risks should be weighed in every
individual critically ill patient before transport
• Anticipate the worst, think about possible
complications and have a plan for how to react
• With sufficient preparation and good equipment
transfer is possible without an adverse event
• Early communication will give you enough time to
organize additional personnel & transfer itself
• Proper use of personnel
• Selection and availability of appropriate equipment

20. Thank you