Acute Care 2: Patient Transport Algorithm
Follow this list to prepare a patient for transfer to another facility.
Airway Needs
- Intubate patients with GCS < 11, confused, combative, or respiratory distress.
- Secure the ET tube and check position with a repeat chest x-ray.
- Ensure adequate paralysis, sedation, and analgesia for transfer.
- Secure patient’s hands to prevent accidental extubation by patient.
Breathing Needs
- Insert and secure orogastric tube.
- Insert chest tube for pneumothorax or hemothorax with repeat chest x-ray.
- Use continuous exhaled CO2 monitoring of intubated patients during transfer.
Circulation Needs
- Secure IV lines (minimum of two). Convert to large bore if patient is hypovolemic.
- Number IV bags to keep track of amount of fluids being given.
- Use O-negative or O-positive blood (males or non-child-bearing females) for patients in shock.
- Keep the patient warm. Use warm fluids. Monitor and document the patient's temperature.
- Be sure to examine patient's back area for any injuries.
Disability Needs
- Maintain spinal immobilization (even after negative x-rays).
- Insert Foley catheter or suprapubic catheter as required. Document output from Foley before transfer.
- Splint fractures. Use sheet or commercial pelvic binder as appropriate to splint pelvic fractures. Confirm distal pulses before transport.
- Use seizure prophylaxis (phenytoin or fosphenytoin load) for paralyzed patients with suspicion for cerebral contusion.
- Consult with receiving hospital or neurosurgical consult before administering steroids in spinal cord injury.
Infection Control
- Tetanus prophylaxis.
- Consider antibiotics.
- Universal precautions by transfer team.
Copies of all Patient Records and Communication
- Include trauma series x-rays (or copies) and subsequent x-rays and CTs.
- Include copies of lab results, ECG, flow sheets. Include the SAMPLE history.
- Communicate directly doctor-to-doctor and nurse-to-nurse from sending to receiving facilities. Send copy of patient demographic sheet.
- Include estimated patient weight and initial GCS.