How do i safely transport the critically ill patient?

Critical care transport is a high-risk but worthwhile activity, but the benefits of transport need to be weighed against the considerable risks of the transport process. The risk can be minimized by appropriate planning, proper equipment, and appropriate staffing, along with pretransport stabilization of the patient. Critical care transport is best undertaken by experienced specialist transport teams wherever possible. This is especially true for pediatric critical care transports. The rate of critical adverse events is 4-17.1% for interhospital critical care transports. Many of these are avoidable. Common events include a reduction in PaO₂/FiO₂ ratio, pneumothorax, ventilator-associated pneumonia, and atelectasis, whereas more serious events include loss of airway, prolonged hypotension, and cardiac arrest. It is difficult to draw firm conclusions regarding the attributable mortality and morbidity associated with transport of critically ill patients. Some, but not all, observational series have reported improved mortality for helicopter transfers compared with ground transportation for interhospital and prehospital transport. This may be related to the greater expertise of HEMS crews. The presence of a physician on a prehospital critical care team may be associated with improved survival, and mortality is reduced in severely injured trauma patients transferred directly to a level 1 trauma center. Prehospital tracheal intubation is a complex intervention and its value is probably related to many factors, including the skill of the provider, patient population, access to drugs to facilitate the intervention, and other aspects of the prehospital care system.