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Critical events during land-based interfacility transport.

Jeffrey M Singh1, Russell D MacDonald2, Mahvareh Ahghari3

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Approximately 1 in 15 urgent land transports experienced critical events, often hypotension. Mechanical ventilation, hemodynamic instability, and longer transport times increased risks, highlighting the need for careful patient preparation and management.

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Area of Science:

  • Emergency Medicine
  • Critical Care Transport
  • Patient Safety

Background:

  • Urgent land-based transport of critically ill patients carries unknown risks impacting patient safety and care.
  • Understanding these risks is crucial for policy development and improving transport protocols.

Purpose of the Study:

  • To determine the incidence of in-transit critical events during urgent land-based critical care transport.
  • To identify patient- and transport-level factors associated with these critical events.

Main Methods:

  • Retrospective cohort study utilizing clinical and administrative data.
  • Inclusion of adult patients undergoing urgent land-based critical care transport between 2005 and 2010.
  • Primary outcome defined as in-transit critical events (adverse events or resuscitative procedures).

Main Results:

  • In-transit critical events occurred in 6.5% of 5,144 transports, with new hypotension being most common (4.4%).
  • Mechanical ventilation, baseline hemodynamic instability, and increased transport duration were associated with higher event rates.
  • Neurologic diagnosis was associated with fewer critical events compared to medical patients.

Conclusions:

  • Critical events affect approximately 1 in 15 urgent land transports.
  • Factors like mechanical ventilation, hemodynamic instability, and transport duration predict critical events.
  • Pretransport hemodynamic instability predicts common hypotension, informing patient management strategies.