Preparation for transport

Following stabilization, the patient is packaged for travel. Unnecessary infusions and medications are discontinued, essential intavenous drugs and infusions are prepared, checked, and labeled, and infusion pumps are activated as required. Safety requirements include Luer-lock junctions and needle-free injection sites for bolus and intravenous additives to reduce the risk of disconnection and needlestick injury. Gloves, masks, eye protection, and sharps disposal bins must be available.

Typed and cross-matched blood likely to be used in transit is checked, reserving 'universal donor' O-negative blood for life-threatening situations. Central venous catheters needed for some infusions (inotropes, total parenteral nutrition in extended missions) are placed. If parenteral nutrition is stopped, rebound hypoglycemia should be prevented by intravenous glucose 10 per cent.

Arterial blood pressure cannulas are inserted if necessary, and all catheters and drains and the endotracheal tube are secured. In suspected cervical blunt injury, a rigid collar is applied, and such patients should be 'log-rolled' when being turned. Effective immobilization of fracture sites is achieved using an extension splint (e.g. the Hare design); correction of angulation may restore limb blood flow. An extremity with vascular occlusion and incipient compartment syndrome needs fasciotomy within 6 to 8 h. During long (e.g. international) trips, immobile limbs may swell, particularly if they are dependent; therefore plaster casts should be split before departure and limbs elevated. Plaster shears should be available. Finally, supplies such as oxygen, suction, and batteries are checked.

Using one stretcher only, which is compatible with transport vehicles, from the referring hospital bed to the receiving hospital bed enhances patient comfort and safety. In extramural missions, the patient, equipment (Table..?.), and bedding are secured to the stretcher by safety harness. A reflecting 'space' blanket or plastic sheet protects the patient from adverse weather or helicopter rotor wash. Stretcher bridges for equipment are useful but are sometimes unwieldy. Eye protection is essential in bright sunlight, which also renders medical procedures such as laryngoscopy difficult.

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Table 2 Requirements of mobile intensive care equipment (monitors, ventilators, and pumps)

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