Annual Update in Intensive Care and Emergency Medicine 2011

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750 P.G. Brindley and T. O’Leary
guideline can increase consistency [34, 35]. This creates a goal-directed structure
that is useful both to control stress and to provide familiarity for team
members unfamiliar with each other’s style. It is also intended to improve efficiency
as routine decisions can be made automatically (e.g., have we confirmed
that suction is available). Using a decision-making guideline also reduces cognitive
overload by freeing the brain to focus on more complex decisions (e.g.,
what advanced interventions will this patient require upon arrival). In short, all
of these strategies are intended to make the patient safer by making the transport
team work better.
Conclusion
Transportation of critically ill patients is time-consuming, resource-dependent,
and potentially dangerous. It is an integral part of modern critical care medicine,
and therefore needs to be ‘done right’. Many national critical care programs
require experience and proficiency in transportation medicine, but training is
often ad-hoc. Furthermore, knowledge of, and adherence to, guidelines is insufficient.
For these reasons, transportation is a substantial patient-safety concern. It
is also a significant educational opportunity.
The goal of a transport curriculum is to encourage structured assessment and
preparation based upon the specifics of the patient, the location, and the
resources (Table 2). Education should also focus upon teamwork, communication,
and decision-making, or what has been called ‘Crisis Resource Management’. In
Table 2. Example of a standardized transport training algorithm
A Assessment Consideration of patient’s condition and needs
Rationale for transport
Capabilities of transport team
Who is involved
C Control Identify a team leader
Identify tasks
Allocate tasks
C Communication With own team
With receiving center (department)
With patient/relatives
With ambulance control
E Evaluation Risk: benefit of transport
Patient reassessment
Urgency of transport
Appropriate mode of transport
P Preparation and packaging Prepare patient
Prepare equipment
Prepare personnel
T Transportation Transport the patient
Based upon the ”Mid Trent Critical Care Network Transfer Training Course” used with the permission of
Dr A. Norton, Lead for Transfer Training