Monitoring During Transport

Transport of critically ill patients within and between hospitals is a common undertaking in an effort to improve patient outcomes. Intrahospital transports are frequently conducted to aid in diagnosis through advanced imaging techniques or to allow image-guided procedures. Interhospital transport is most frequently conducted to bring patients to specialized care, including centers of excellence for cardiac, trauma, transplant, and respiratory failure. Transport outside the hospital can be accomplished by ground or air, the latter including fixed-wing and rotor-wing aircraft. Often overlooked, transport of patients from the scene of an accident or illness to the hospital by emergency medical services is less sophisticated but more common than the other methods combined. Patients are also routinely transported to and from the operating room, a form of transport not commonly studied. Risks are inherent to transport, and an analysis of risks and benefits must be part of any risk-mitigation strategy. Monitoring the patient during transport by attendants and equipment is a key component of risk mitigation. Quicker transport times and specialized transport teams are associated with improved outcomes, whereas severity of illness is a harbinger of untoward complications. The type of monitoring during transport varies widely with the environment, the skill of the attendants, and the severity of patient illness. Standards for patient monitoring during transport are available, but they are predominantly based on expert opinion. This paper reviews guidelines and the risks of transport as a template for required monitoring, and it discusses common mishaps associated with transport and how these can be avoided with appropriate monitoring.