For my ambulance colleagues, you may very soon start to do alot of ITU transfers due to hospital capacity. No doubt this will mostly be done with a hospital team but in some cases may not. Here is a quick thread on transfer basics and things to consider.

This is only intended to be a few ideas to help anyone in-experienced and is not exhaustive. It is deliberately basic and simple as I have no doubt crews will not be thrown into complex transfers alone. Also, these are only my views so please do not go against local policy.

Planning: despite normally being stable prior to transfer, by nature, critical pt are unstable and may deteriorate. Plan for this and know where you are going, expected journey time accounting for traffic conditions and what hospitals are along the route incase of emergency.

Equipment: If a team is not travelling, you ideally won’t take unfamiliar devices. If you do, the least you should know, and plan for/discuss is how to manage failure. I.e a syringe pump giving inotropic support or ongoing sedation that may be able to be given manually.

Equipment: Is different in subtle ways and it won’t be a simple case of copying hospital settings. If moving a pt from hospital equipment to yours, don’t immediately leave. Give pt time to “settle” on your equipment and make any changes to settings necessary to maintain the pt.

Vehicle: Ensure normal vehicle checks are complete, you know where your own equipment is and that it is working. Also make sure that electrical/12V/USB ports all work incase they are needed for transfer equipment. Have all rescue kit (airways, BVM etc) to hand.

Oxygen: An oxygen dependent or ventilated pt uses a lot of O2 and this needs to be calculated along with extra incase of delays. Formulas that can be used:
2 x flow (L/min) x length of transfer (min)
2 x transport time in minutes x (minute volume x FiO2) + ventilator driving gas

Airway: always important but vital for a pt who has an airway adjunct in place prior to tx. Plan for immediate actions if the pt loses this adjunct during tx. Have emergency kit laid out PRIOR to transfer and allocate pre-planned roles incase of an airway emergency during tx.

Breathing: A ventilated pt will have a ventilation strategy based on their condition. Try to have a basic understanding of this incase you need to take over with a BVM in the event of a ventilator failure. ALWAYS have rescue kit laid out and to hand incase of emergency enroute.

Circulation: The pt may be on some sort of circulatory support (fluids, pressors, inotropes etc) dependant on their underlying condition. Again, try to understand their current fluid status and support needs incase you need to intervene or have an equipment failure enroute.

Disability: If a patient is sedated/anaesthetised be vigilant for signs this may be wearing off. Some signs to look for are tearing, increase in heart rate/BP or a Curare cleft on waveform capnography. Be aware that pt sedation needs may change due to movement during transfer.

Monitoring: In the sedated/anaesthetised pt, monitoring may be your first indicator that something is changing. Don’t assume strange values are due to movement and constantly check your pt. If something changes, start at the pt and work back to the monitor to look for issues.

Again, this is only some short ideas to try to help during difficult times. Anyone please feel free to get in touch via DM with any questions or if I can help or support in any way.