Transport of Patients

 Mission planning will need to account for extra time in preparation, don and doffing, cleaning of the clinical gear and decontaminating air assets. 

During a pandemic, limited clinical resources, transport assets and intensive care resources at receiving facilities may impact responses to requests for aeromedical and ground based patient transport. Mission planning will need to account for extra time in preparation, don and doffing, cleaning of the clinical gear and decontaminating air assets.

This section deals with both inter and intra facility transport of patients.

We align with:                                                       

1. NSW Air Ambulance Aeromedical Transport of a COVID-19 Patient.
2. MedSTAR CPG Advanced Airway Management. 
3. Australian Government Department of Health, Coronavirus (COVID-19) information for aeromedical retrieval of patients. [Link] 

We recommend:

1.  The health and safety of all aeromedical staff as well as the service providers is paramount. All operational staff must be current and competent in infection control procedures and able to safely don and doff following their respective service guidelines.
2. Where possible do not use air assets and travel by road.
3. Central clinical coordination staffed with senior clinician decision makers to discuss the requirement for patient transport.
4. Multi-party teleconferences between retrieval services and key stakeholders, to enable senior clinicians to discuss cases in a timely fashion providing support, advice and guidance as well as retrieval team if required.
5. Prior to transport of suspected or confirmed COVID-19 cases, clear agreement between referring and receiving facilities that transfer is clinically indicated and appropriate.
6. Communication of patient arrival times via well-established channels to receiving hospitals to ensure team is met and escorted.
7. Where possible, transported patients should be taken directly to inpatient bed locations bypassing the ED and limiting exposure and number of transfers.
8. Where a decision is made not to transport patients, that clear communication, advice and support channels are provided for the treating clinical team.
9. All patient transfers (pre, inter and intra-hospital) should be undertaken by clinicians with:
   • The ability to set-up, operate, troubleshoot and maintain the specialist medical equipment utilised for critical care transports.
   • Experience in managing the patient’s clinical condition.
   • Preferably, current pre-hospital and retrieval medicine training (pre-, inter-hospital). If this is not possible, discuss options with the medical retrieval coordinator.
10. As per ANZICS/MJA guidelines, patients should not be transferred on NIV or HFNO. Aerosolising procedures should not be undertaken during transport including intra- hospital transport.
11. Patients receiving supplemental oxygen should have a surgical mask placed over their oxygen delivery device.
12. Where possible, transporting clinicians should not walk or be seated in front of the patient.
13. During intra-hospital transport a designated ‘clean’ staff member is required to open doors, push lift buttons and to watch the team and patient to ensure they do not contaminate surfaces within the health facility.
14. To minimise requirements for intra-hospital transport to radiology, consideration should be given to the utility of bedside point of care ultrasound (POCUS) for chest investigation where the skill set is available.