Transporting the critically ill

Over 10,000 intensive care patients are transferred each year in the UK. Of these, about 90% are accompanied by staff from the referring hospital. The escalating complexity of healthcare, the concentration of skills into specialized regional centres, and the relative lack of intensive care bed availability have all led to an increase in the frequency of transfer of critically ill patients between hospitals.The care delivered in the restricted environments encountered during patient transfer, whether it be within or between hospitals, should at least attempt to emulate the detailed attention provided in the hospital intensive care unit, and it is the responsibility of the transport team to provide this care outside the ICU. This is achieved by training staff, selecting appropriate equipment and detailed planning. The likelihood of success is increased by anticipating and preventing complications and avoiding hazards to both patient and the transfer team.This article provides an overview of the hazards, organization and planning of patient transfers, and highlights the importance of interdisciplinary teamwork, good communications and appropriate decision-making. It also examines the special situations encountered during the transfer or retrieval of patients with complex needs, such as those requiring intra-aortic balloon counterpulsation or extracorporeal membrane oxygenation, and discusses the challenges and opportunities that lie ahead.