Transfer of critically ill patients is a procedure that is many a time unavoidable and yet, is fraught with reluctance and undertaken with reservations. Understandably so, as these patients are at the most unstable even in an environment where best possible medical and technical help is available. Transportation of these patients involves exposure to settings which may be suboptimal and in addition, access to resource personnel is limited and may not be immediately available. Authors have rightly commented that such transfers are akin to expeditions for which thorough preparation is required and surprises are to be expected (Droogh et al, 2012). Before undertaking such transfers, the necessity and indication for transportation of the patient is evaluated along with the patient’s risk factors which are usually a part of the critical illness like mechanical ventilation, haemodynamic instability etc. If it is determined that the transfer will help to achieve a better outcome in terms of diagnosis, management or for any other reason, patients are transported despite their critical status with all the precautions for minimising the risk of adverse events. Herein, it is valuable to understand the risk benefit analysis for the transfer of critically ill patients so that evidence based decisions can be made in the best interests of the patient.
Another arena where critically ill patients undergo transportation is from the site of inciting injury or event to the hospital. In these cases, patients are even more critical and not optimised, yet need urgent medical care and life saving interventions. Prehospital care is administered at the site of injury and en route. For these cases, transfer to a medical facility is indicated irrespective of other factors and risk is more in case timely medical aid is not provided. Indications for transport As mentioned above, transfer of critically ill may be done from the site of injury to the hospital (primary transfer), or it may be that of an already admitted or hospitalised patient (secondary transfer) (Gray, Bush & Whiteley, 2004). A hospitalised critically ill patient may undergo interhospital or intrahospital transfer. Interhospital transfer is indicated for patients who need specialised care such as trauma patients, acute coronary syndrome patients, burns patients, spine injury patients, patients with head trauma or stroke, or patients who require advanced monitoring. Regionalisation or centralisation of medical care as well as development of dedicated specialised centres has led to an increase in the number of such transfers. However, there is no consensus among medical community about the criteria for patient transfer and it is still a subjective decision (Iwashyna, 2012). Gray, Bush and Whiteley (2004) in their review very clearly listed the reasons for which transport of critically ill patients is done. Briefly, they listed reasons like absence of critical care facilities at the transferring hospital, unavailability of diagnostic facilities and normal clinical expertise, repatriation and non-clinical transfer. Intrahospital or with-in hospital transfer of critically ill patients is done between facilities such as intensive care unit (ICU), emergency department (ED), radiology and imaging suites, and operation theatres. Benefits All these transfers are done with the aim of achieving better outcome for the patient. Benefits can be categorised in the context of mortality and non mortality (Iwashyna, 2012). So far as interhospital transport is concerned, patient may benefit from specialised care in terms of infrastructure, medical specialists and trained staff and personnel. A dedicated centre is more likely to have advanced treatment, medical and surgical options for a severely ill patient. There may even be a re-evaluation of the diagnosis and