Safely moving a critically ill adult to CT, theatre, cath lab or another hospital: is the trip worth it, risk stratification, team and equipment, a pre-departure checklist, monitoring in transit, and handover on arrival.
At the bedside
Timed steps- 1
Will the result change management?
DecideWeigh the benefit of the test/procedure/transfer against transport risk; consider bedside alternatives (POCUS, portable X-ray). Combine trips (e.g. CT head and abdomen together). Obtain consent where possible and inform family.
- 2
Risk-stratify and choose the team
PlanUnstable or high-support patients (vasopressors, FiO₂ >0.5 or PEEP >10, recent intubation, raised ICP) need a doctor competent in airway management and resuscitation plus a critical care nurse; stable patients may go with a trained nurse. Minimum two people for any critically ill patient.
- 3
Secure ABCDE before moving
StabiliseAirway: intubate electively if it may deteriorate; secure tube; record depth; ETCO₂. Breathing: on transport ventilator for 10–15 min before departure with acceptable ABG/SpO₂. Circulation: two working IV lines, vasopressors running steadily on charged syringe drivers, spare syringes prepared. Disability: sedation and analgesia adequate; seizures controlled; spine protection if trauma. Exposure: warm, drains clamped/secured per surgeon, catheter bag emptied.
- 4
Equipment and drugs
EquipTransport monitor (ECG, SpO₂, invasive/non-invasive BP, ETCO₂), transport ventilator with alarms, self-inflating bag with PEEP valve and mask, suction, airway kit, defibrillator for high-risk patients, oxygen calculated for twice the expected time, emergency drugs (adrenaline, sedation, fluid), and the patient's notes/imaging.
- 5
Call ahead
CommunicateConfirm the receiving area/hospital is ready (CT slot, bed, lift held); doctor-to-doctor ISBAR call for inter-hospital transfers; agree the route and who to call for help.
- 6
Read the checklist aloud
CheckRun a structured pre-departure checklist (see table) as a team, just before leaving.
- 7
Monitor and record
TransitContinuous ECG, SpO₂, ETCO₂ and BP; observations recorded at least every 5–15 min; watch tubes and lines at every move (bed → CT table). Pre-plan responses to desaturation, hypotension and accidental extubation.
- 8
Handover and document
ArriveStructured handover to the receiving team; transfer monitoring and infusions one at a time; document events and adverse incidents and report them.
Vasopressor during transfer
Noradrenaline (norepinephrine)
- Dose
- 0.05–0.5 mcg/kg/min
- Range
- 0.05–0.5 mcg/kg/min
- Preparation
- 4 mg in 50 mL = 80 mcg/mL; carry a second filled syringe
- Worked example
- 70 kg at 0.15 mcg/kg/min = 10.5 mcg/min = 7.9 mL/h
Sedation for ventilated transfer
Propofol
- Dose
- 0.5–4 mg/kg/h
- Range
- 0.5–4 mg/kg/h
- Preparation
- 1% undiluted = 10 mg/mL
- Worked example
- 70 kg at 2 mg/kg/h = 140 mg/h = 14 mL/h
Analgesia during transfer
Fentanyl
- Dose
- 25–100 mcg boluses; infusion 25–200 mcg/h
- Range
- 25–200 mcg/h
- Preparation
- 500 mcg in 50 mL = 10 mcg/mL
- Worked example
- 70 kg at 1 mcg/kg/h = 70 mcg/h = 7 mL/h of 10 mcg/mL
Pre-departure checklist (read aloud)
| Domain | Check |
|---|---|
| Patient | Identity band, consent/family informed, notes, imaging, drug chart, referral letter |
| Airway | ETT secured, depth recorded, cuff pressure, ETCO₂ waveform, suction, bag-mask, spare tube and airway kit |
| Breathing | Transport ventilator settings/alarms checked; stable for 10–15 min; ABG acceptable; oxygen calculated ×2 plus reserve |
| Circulation | Two working IV lines; vasopressors on charged pumps with spare syringes; fluid bolus available; arterial line zeroed |
| Disability | Sedation/analgesia adequate; pupils/GCS recorded; seizure plan; spinal precautions if trauma |
| Exposure | Warm; drains/catheters secured; pressure areas protected |
| Equipment | Monitor and pumps charged; defibrillator for high-risk; emergency drugs; phone numbers |
| Destination | Receiving team ready; lift/route clear; handover planned |
Transfer risk and escort (practical guide)
| Risk level | Typical patient | Escort |
|---|---|---|
| Low | Stable, no vasopressor, FiO₂ ≤0.4, not ventilated | Trained nurse ± attendant |
| Moderate | Stable on low-dose vasopressor or NIV/HFNC, or stable ventilated with low support | Critical care nurse + doctor available/accompanying per local policy |
| High | Unstable, rising vasopressor, ventilated with high FiO₂/PEEP, raised ICP, recent intubation | Doctor competent in airway and resuscitation + critical care nurse |
Adapted practical categories; align with the unit's policy and the ISCCM position statement.
Calculators for this topic
Infusion rate from mcg/kg/min
Pump rate in mL/h for drugs dosed in mcg/kg/min (noradrenaline, adrenaline, dobutamine, milrinone, nitroglycerin by weight).
Infusion rate from per-kg-per-hour dose
Pump rate for drugs dosed per kg per hour (insulin U/kg/h, midazolam mg/kg/h, propofol mg/kg/h, fentanyl mcg/kg/h, dexmedetomidine mcg/kg/h).
Infusion rate from a fixed hourly or per-minute dose
Pump rate for non-weight-based infusions such as vasopressin (U/min), labetalol (mg/min) or amiodarone (mg/h).
Oxygen cylinder duration
Minutes of oxygen left at a given flow.
Glasgow Coma Scale
Eye + Verbal + Motor (3-15). Record components, e.g. E3 V4 M5.
References
- 1
- 2
- 3
- 4
- 5
Before any transfer
Step 1 of ~3
Decision and preparation sequence.
Decision: Will it change management? No bedside alternative?
Based on Zirpe KG, Tiwari AM, Kulkarni AP, et al; Fanara B, Manzon C, Barbot O, Desmettre T, Capellier G. Educational use; follow local protocol.
Pathophysiology
Transport exposes patients to changes in ventilation (circuit disconnection, transport ventilator performance, derecruitment), haemodynamics (interrupted infusions, movement, acceleration), temperature and monitoring gaps — on top of reduced staff and equipment.
Evidence
- ISCCM position statement (2025): Indian recommendations on intrahospital transport — planning, risk stratification, staffing, equipment, checklists, monitoring, documentation and quality indicators.
- ACCM/SCCM guidelines (Warren 2004): inter- and intrahospital transport — communication, personnel, equipment, monitoring.
- Fanara 2010 (French recommendations): adverse events reported in a wide range of transports (up to about two-thirds in some series); most are minor but serious events (desaturation, hypotension, arrest) occur; risk factors include high PEEP, sedation needs and fluid resuscitation before transport; checklists reduce events.
- Droogh 2015 review: inter-hospital transfers by specialised teams with standardised equipment are safer; transfers remain high-risk episodes.
Controversies
- Routine CT in unstable patients vs bedside imaging.
- Specialist retrieval teams vs referring team escorts in low-resource settings.
🇮🇳 India notes
- In India, ICU–CT distances can be long with shared lifts; arrange a held lift and security escort.
- Advanced life support ambulances with transport ventilators are often private and variable in quality — inspect equipment yourself before departure.
- NABH standards require documented transfer policies; the ISCCM 2025 position statement provides India-specific guidance.
References
- 1
- 2
- 3
- 4
- 5
Test yourself
Module quiz · score 70% to complete the module
Educational reference for trained clinicians. Check doses against your hospital protocol and the patient in front of you.