Transport personnel must be available at short notice. In the United States the independent transport companies are established in large part as for-profit organizations. In the United Kingdom, dedicated transport services are an exception, and it is often difficult to release physicians and nurses from other duties and patients. Transports may be time consuming, and when personnel are removed from in-hospital patient care, their absence must be covered. In the United Kingdom, some pediatric referral centers have developed their own retrieval teams. However, this is not a common practice in the United States.
Transport teams must be adequately clothed and equipped. Weather conditions fluctuate and environmental conditions may in part be influenced by the mode of transportation. Coveralls for flying, as well as helmets with headsets for communication and protection, are used. In the United Kingdom, the National Health Service pension and accident provisions are inadequate and usually hospitals must take out specific insurance policies. North American transport systems are usually self-insured or insured through their provider.
Transfer agreements should be established beforehand so that the administrative aspects of transporting patients do not delay the actual transport. The responsible consultant should be notified of each transfer before it takes place so that he or she has the opportunity to discuss the patient's requirements with the transport team. Methods such as flight following and electronic location of ground services have allowed agencies to attempt to cover large geographical areas in the shortest possible response time.
While a patient is in transit, comprehensive medical records should be kept much as if he or she was an in-patient. A minimum data set such as that shown in TableJ? should be recorded.
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Table 2 Minimum patient information
A hard copy of the transport data should be included in the patient's record at the receiving hospital. Quality improvement and continued quality assurance should be performed in order to ascertain that the best mode and safest method of transport were used. Morbidity and mortality meetings and audit meetings should be part of quality assurance for transport systems.
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