What Nurses Need to Know About Critical Care Transport with Katherine Stradling, RN

Patients require transportation for many reasons: to an increased level of care, a decreased level of care, a procedure, or for imaging. Katherine Stradling, BSN, RN, CCRN, TCRN discusses the science of transport, what it’s like in the ambulance, and what bedside nurses can do to facilitate safe transport.

Objectives

1. Listeners will be able to describe the difference between basic life support (BLS) transfer vs. critical care transport (CCT)
2. Listeners will be able to explain the physiologic demands placed on patients during transport
3. Listeners will be able to describe how the sending nurse can prepare the patient for safe transport

BLS v. ALS v. CCT

Note: Protocols differ by county and organization

• BLS transport is for stable patients who will not require cardiac monitoring or medications during transport. It is typically a team of two or more EMTs. 
• ALS transport includes a paramedic who can perform cardiac monitoring, chronic ventilators, and administer some medications. As Katherine explained, this set up is often unavailable, and thus patients who qualify for ALS transport often are transported by CCT
• CCT is a team including a critical care RN and two EMT. Their scope includes, but is not limited to cardiac monitoring, medication administration and titration, airway management. CCT is for patients who are not stable and will require intervention during transport.

The Science of Patient Transport

1. Increase O2 demand
2. Increase ICP
3. Nausea
4. Increased sympathetic response
5. Variable BP changes

How the sending nurse can help facilitate safe transport

1. Pre-medicate:this often means for pain and nausea
2. Have paperwork ready to go
3. Pull more meds than you think you need. Transportation is often delayed due to variable like traffic.
4. Make room for the CCT crew to come in with their stretcher
5. Spike hard-to-spike meds ahead of time (this is difficult to do on a bumpy ride!)
6. Provide the receiving facility a complete and honest report. Make sure that they have all of the equipment the patient will need.

Tip: If you’re saying to yourself “the patient should be fine”, just remember that the ambulance has finite supplies and team members. It’s just the RN and EMTs out there on the road or in a helicopter, so give them more medications and supplies than you’d think and get your patient as stable as possible before they go.

Relevant Links

Hands to Hearts is a volunteer organization who believes that no one should die of treatable medical emergencies due to lack of education and resources. The organization helps build the first response system and offer life support courses in developing areas across rural Mexico.