Interhospital transport of the extremely ill patient: The mobile intensive care unit

Gebremichael, Mengistu Welday; Borg, UB; Habashi, Nader M.; Cottingham, Christine; Cunsolo, L; McCunn, Maureen; Reynolds, H. Neal

doi:10.1097/00003246-200001000-00013

Cited by 95 publications

(55 citation statements)

References 33 publications

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“…ST segment elevation myocardial infarction (STEMI), acute trauma requiring surgery, stroke), taking the time to optimise the patient's haemodynamic and respiratory status prior to transport has been found to improve morbidity and mortality. [16,17] In fact, one study showed a shorter hospital stay when paramedics stayed longer at the referring facility stabilising the patient. [18] In order to achieve patient stability, a variety of procedures and medications must be administered by the CCT team.…”

Section: Discussionmentioning

confidence: 99%

“…[18] In order to achieve patient stability, a variety of procedures and medications must be administered by the CCT team. [16][17][18] The current paramedic scope of practice locally is mainly focused on emergency, rather than critical care. [4] Often paramedics are left to initiate or monitor medication infusions that are outside of their scope of practice (e.g.…”

Section: Discussionmentioning

confidence: 99%

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The capabilities and scope-of-practice requirements of advanced life support practitioners undertaking critical care transfers: A Delphi study

Venter

Stassen

2016

S Afr J Crit Care

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Background. Critical care transfers (CCT) refer to the high level of care given during transport (via ambulance, helicopter or fixed-wing aircraft) of patients who are of high acuity. In South Africa (SA), advanced life support (ALS) paramedics undertake CCTs. The scope of ALS in SA has no extended protocol regarding procedures or medications in terms of dealing with these CCTs. Aim. The aim of this study was to obtain the opinions of several experts in fields pertaining to critical care and transport and to gain consensus on the skills and scope-of-practice requirements of paramedics undertaking CCTs in the SA setting. Methods. A modified Delphi study consisting of three rounds was undertaken using an online survey platform. A heterogeneous sample (n=7), consisting of specialists in the fields of anaesthesiology, emergency medicine, internal medicine, critical care, critical care transport and paediatrics, was asked to indicate whether, in their opinion, selected procedures and medications were needed within the scope of practice of paramedics undertaking CCTs. Results. After three rounds, consensus was obtained in 70% (57/81) of procedures and medications. Many of these items are not currently within the scope of paramedics' training. The panel felt that paramedics undertaking these transfers should have additional postgraduate training that is specific to critical care. Conclusion. Major discrepancies exist between the current scope of paramedic practice and the suggested required scope of practice for CCTs. An extended scope of practice and additional training should be considered for these practitioners. There is currently a critical shortage of intensive and specialist care in South Africa (SA). [1] In fact, 77% of state healthcare facilities and 16% of private healthcare facilities do not have intensive or high-care capacity.[1] Owing to this shortage, adequate district and provincial healthcare might not be available in many areas, [2] necessitating frequent transfer of patients to urban tertiary centres for specialist care.Internationally, paramedics undertaking critical care transfers (CCTs) have extended scope of practice when compared with standard emergency paramedics in order to be equipped for these high-acuity patients.[3] Locally, however, all paramedics registered as advanced life support (ALS) practitioners may undertake CCTs. [4] No extended training or additional scope of practice is given to these paramedics who might need to intervene to stabilise patients for transfer.[4] Studies have shown that adverse events (AEs) during CCTs are significant and proportionate to the level of training and experience of the transferring practitioner. [5,6] A prospective 1-year audit conducted in SA in 2001 focused on CCTs of paediatric patients in a low-resource setting.[7] The study found that the transfers were predominantly undertaken by paramedics (82%) via road ambulance (76%). [7] It was found that a number of technical AEs such as inadequate monitoring, absent venous access, and malpositioning of e...

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

The capabilities and scope-of-practice requirements of advanced life support practitioners undertaking critical care transfers: A Delphi study

Venter

Stassen

2016

S Afr J Crit Care

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“…The importance of transporting critically ill patients to tertiary hospitals for advanced care has been well described. gebremichael et al 17 showed that critically ill patients can be transported safely and that transfer of patients with severe respiratory failure to tertiary care centers has a survival advantage. Ridley and Carter 18 reported that patients have a predictable physiological response to transfer, independent of the severity of the underlying disease; that is, patients with higher critical illness scores did not have worse outcomes during transport.…”

Section: Discussionmentioning

confidence: 99%

Inhaled Nitric Oxide to Improve Oxygenation for Safe Critical Care Transport of Adults With Severe Hypoxemia

Teman

Thomas²,

Bryner

et al. 2015

American Journal of Critical Care

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“…In addition, a nurse accompanied the patient in all four studies that reported transport team composition. Interfacility transport is increasingly becoming the jurisdiction of highly trained and specialized transport personnel [35][36][37][38], with at least one paediatric study demonstrating significantly decreased morbidity associated with the use of such teams [36]. Professional guidelines have suggested that transport of unstable critically ill adults should be accompanied by either a physician or a nurse, preferably with additional training and experience in transport medicine [22].…”

Section: Discussionmentioning

confidence: 99%

Outcomes of interfacility critical care adult patient transport: a systematic review

MacDonald

Adhikari

Scales

et al. 2006

Can J Anesth/J Can Anesth

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Interhospital transport of the extremely ill patient: The mobile intensive care unit

Cited by 95 publications

References 33 publications

The capabilities and scope-of-practice requirements of advanced life support practitioners undertaking critical care transfers: A Delphi study

The capabilities and scope-of-practice requirements of advanced life support practitioners undertaking critical care transfers: A Delphi study

Inhaled Nitric Oxide to Improve Oxygenation for Safe Critical Care Transport of Adults With Severe Hypoxemia

Outcomes of interfacility critical care adult patient transport: a systematic review

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