Transfer vehicle

The type of vehicle used will depend on the distance to be traveled, the weather conditions, geographical considerations, and availability.

Air ambulances will generally be suitable for longer journeys and when road access is poor. Helicopters are recommended for journeys of 50 to 150 miles and for sites without landing strips; fixed-wing aircraft are used for journeys of over 150 miles.

Land ambulances are more suitable for shorter journeys of less than about 50 miles distance or 2 h duration. They provide good lighting and heating, have constant two-way communication, and carry a defibrillator, suction apparatus, and oxygen. All equipment must be checked routinely.

The availability of specialized ambulances or mobile ICUs varies from country to country. In the United Kingdom they are usually only available to dedicated transfer teams, but are more common in the United States and continental Europe. Designs vary widely, but usually include increased stores of oxygen and transfer equipment, more complex monitors, and mountings to secure the equipment.

The position of the patient in the ambulance varies according to design. The trolley must be well secured, but adequate access to the patient, particularly the head, is essential. Theoretically the effects of acceleration and deceleration will be diminished by fixing the trolley from side to side. In practice, a standard position with the head to the front of the ground vehicle poses few problems. With fixed-wing aircraft, owing to the effects of acceleration on take-off, patients with a propensity for an elevated intracranial pressure should be placed head forward.

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