Patient Transport and Respiratory Care Guidelines

Transporting a patient is more than moving someone from one location to another. During transport, patients may be separated from the equipment, personnel, and resources normally available at the bedside, which can increase the risk of respiratory, cardiovascular, and equipment-related complications.

This is especially important for patients who require supplemental oxygen, artificial airways, mechanical ventilation, invasive monitoring, or other forms of life support.

Safe transport depends on careful assessment, preparation, monitoring, equipment management, communication, and readiness to respond quickly if the patient’s condition changes.

 

What Is Patient Transport?

Patient transport refers to the movement of a patient within a healthcare facility or between separate healthcare facilities. Intrahospital transport may involve moving a patient from an intensive care unit to radiology, surgery, magnetic resonance imaging, or another hospital department. Interhospital transport involves moving a patient from one facility to another, often because the receiving hospital provides a higher level of care or a specialized service that is not available at the sending facility.

Patients may be transported by wheelchair, stretcher, hospital bed, ambulance, helicopter, or fixed-wing aircraft. The method depends on the patient’s condition, distance of travel, equipment requirements, urgency, terrain, weather, and availability of transportation resources.

The general goal is to maintain the same level of clinical support during movement that the patient receives while stationary. Oxygenation, ventilation, airway security, hemodynamic stability, medication delivery, monitoring, and patient comfort should continue throughout transport whenever possible.

Assessing the Patient Before Transport

The first step in safe transport is determining whether the patient is stable enough to be moved. Transport should not begin simply because a diagnostic study or procedure has been ordered. The patient’s current condition must be evaluated, and the benefits of transport should outweigh the risks.

Important factors include:

• Heart rate and rhythm
• Blood pressure
• Respiratory rate
• Oxygen saturation
• Ventilatory status
• Level of consciousness
• Airway stability
• Skin color and perfusion
• Pain
• Dizziness
• Shortness of breath
• Hemodynamic stability
• Strength and ability to tolerate movement

Patients who are severely unstable may require additional stabilization before transport. A mechanically ventilated patient, for example, should not be transported if adequate oxygenation, ventilation, airway control, or cardiopulmonary monitoring cannot be maintained during the trip.

Patients with respiratory disease may prefer sitting upright or leaning slightly forward because these positions can reduce the work of breathing. When clinically appropriate, maintaining a comfortable respiratory position during preparation and transport may improve tolerance.

Preparing the Patient for Movement

Movement should be gradual when a patient has been confined to bed. Sudden positional changes can cause dizziness, weakness, or orthostatic hypotension.

A patient who is preparing to stand may first be assisted into a sitting position. The legs can then be allowed to hang over the side of the bed for a short period. The healthcare provider should watch for dizziness, pallor, weakness, changes in breathing, or other signs of intolerance.

Once the patient feels stable, assistance can be provided while standing. Depending on physical ability, some patients may require one healthcare worker, while others may require two people or mechanical assistance.

The bed should be lowered before transferring the patient, and the wheels should be locked. Intravenous lines, oxygen tubing, drainage systems, chest tubes, urinary catheters, feeding tubes, ventilator circuits, and monitoring cables should be positioned so that they are not accidentally pulled or disconnected.

Safe Body Mechanics

Healthcare workers must protect both themselves and the patient during transfers. Poor lifting technique can cause back injuries, patient falls, or accidental removal of medical devices.

The caregiver should maintain a stable stance, keep the spine relatively straight, and use the muscles of the legs when lifting. Twisting while carrying or supporting a patient should be avoided whenever possible.

The patient should also be told what is going to happen before movement begins. Clear instructions help the patient participate appropriately and reduce sudden movements that could create instability.

Monitoring During Ambulation

Some hospitalized patients can begin walking once they are physiologically stable and severe pain has been controlled. Early ambulation can help reduce complications associated with prolonged bed rest, including atelectasis, muscle weakness, pressure injuries, and loss of functional mobility.

Initial ambulation may last only 5 to 10 minutes depending on the patient’s condition. Duration and distance can gradually increase as tolerated.

The caregiver should monitor:

• Level of consciousness
• Respiratory effort
• Skin color
• Oxygen saturation when indicated
• Heart rate
• Patient strength
• Pain
• Shortness of breath
• Dizziness
• Overall tolerance

Note: A chair should be available nearby when ambulating a weak or high-risk patient so the patient can sit quickly if distress develops. After ambulation, the duration, distance when relevant, patient tolerance, symptoms, and clinical response should be documented.

Planning Before Transport

Preparation is one of the most important parts of transport. Problems that would be easily corrected in an intensive care unit can become serious during transport if equipment or supplies are unavailable.

A transport checklist can reduce the risk of forgetting essential items. This is particularly important during interhospital transport because obtaining replacement equipment after departure may be difficult or impossible.

Before leaving, equipment should be checked for correct operation. Batteries should be fully charged, spare batteries should be available when appropriate, and replaceable components should be inspected.

The transport team should also anticipate what the patient might need during the trip. Respiratory care does not stop simply because the patient leaves the bedside.

Communication Before Transport

Good communication between departments and team members reduces delays and prevents confusion.

The receiving department should be contacted before departure to confirm that it is ready for the patient. Any specialized equipment or personnel required at the destination should be available before the patient arrives.

Team members should also understand their responsibilities. One healthcare worker may manage the airway and ventilator, while another manages intravenous medications, drainage systems, and monitoring equipment.

Note: For more complex patients, responsibilities should be clearly assigned before movement begins.

Basic Monitoring During Transport

Monitoring should remain as similar as possible to the monitoring used before transport.

For critically ill patients, basic monitoring may include:

• Heart rate
• Respiratory rate
• ECG
• Pulse oximetry
• Noninvasive blood pressure

A portable multichannel monitor can often provide these measurements. Temperature monitoring may be necessary in patients who are at risk for hypothermia, including infants, trauma patients, and patients exposed to cold transport environments.

If a patient already requires invasive monitoring, it may need to continue during transport. A hemodynamically unstable patient with an arterial catheter, for example, may require continuous invasive blood pressure monitoring. Patients with neurologic injuries may require continued intracranial pressure monitoring.

Capnography During Transport

Capnography is especially useful in mechanically ventilated patients because it provides continuous information about ventilation.

End-tidal carbon dioxide monitoring can help identify:

• Hypoventilation
• Hyperventilation
• Airway disconnection
• Changes in pulmonary perfusion
• Ventilator malfunction
• Changes in respiratory status

Capnography may be particularly valuable in patients whose carbon dioxide level must be carefully controlled, including some patients with traumatic brain injury.

If precise carbon dioxide control is required, an arterial blood gas may be obtained before transport. The relationship between PaCO₂ and end-tidal CO₂ can then help clinicians interpret capnography during the trip.

Oxygen During Patient Transport

Any patient receiving supplemental oxygen must have an adequate supply for the entire transport.

The respiratory therapist should calculate how long the available oxygen cylinder will last at the prescribed flow or ventilator consumption rate. A safety reserve should always be included because transports can take longer than expected.

For many transports, the oxygen supply should cover the estimated travel time plus at least approximately 30 minutes of additional use. For interhospital transport, even larger reserves may be appropriate because traffic, weather, mechanical problems, or delays at the receiving facility can extend travel time.

Some transport recommendations call for carrying enough oxygen for considerably more than the expected one-way trip when access to backup supplies will be limited.

Oxygen Flowmeters During Transport

A Bourdon-type flowmeter may be useful during transport because it can function when positioned horizontally. This can be advantageous when an oxygen cylinder cannot remain upright.

However, the clinician must understand its limitations. A Bourdon flowmeter is not backpressure compensated. If downstream resistance increases, the indicated flow may be higher than the amount actually reaching the patient.

This means the therapist must evaluate both the device and the clinical response of the patient rather than relying exclusively on the flowmeter reading.

Compressed Gas Cylinder Safety

Oxygen cylinders contain gas under high pressure and must be secured carefully during transport.

Cylinders should be placed in approved holders or transport carts. They should never be left loose on a stretcher or bed.

Important safety practices include:

• Secure the cylinder before movement
• Protect the cylinder valve
• Avoid dropping or striking the cylinder
• Do not drag or roll cylinders
• Keep appropriate labels visible
• Use protective caps when required
• Keep cylinders away from situations where the valve could be damaged

Note: A damaged cylinder valve can create a serious projectile hazard.

Transporting Mechanically Ventilated Patients

Transport becomes more complicated when a patient is dependent on mechanical ventilation.

These patients may have little or no ability to compensate for interruption of ventilatory support. A problem involving the ventilator, artificial airway, oxygen source, or breathing circuit can rapidly produce hypoxemia or respiratory arrest.

A transport plan should therefore address the ventilator, airway, oxygen source, power requirements, emergency backup equipment, personnel responsibilities, and monitoring.

Selecting a Transport Ventilator

A transport ventilator should be portable, reliable, durable, and appropriate for the patient’s ventilatory needs.

Important features may include:

• PEEP
• Pressure support
• Volume-controlled ventilation
• Pressure-controlled ventilation
• Adjustable respiratory rate
• Adjustable tidal volume or inspiratory pressure
• Oxygen concentration control
• Expired tidal volume monitoring
• Airway pressure monitoring
• Audible and visual alarms

Note: A transport ventilator should also be easy to operate while the patient is moving. Controls, settings, and monitored values should remain visible under different lighting conditions.

Pneumatic and Electrically Powered Ventilators

Transport ventilators may use compressed gas, electrical power, batteries, or combinations of these sources. Pneumatically powered ventilators may be practical for some short intrahospital transports because they can operate using compressed gas.

Interhospital transport often requires electrically powered ventilators with battery capability because the patient may spend extended periods without access to wall power.

Ideally, an electrically powered transport ventilator can operate from alternating current and direct current sources while also containing an internal battery. Battery duration must be checked before transport, and the device should remain connected to power as long as possible before departure.

Transitioning to the Transport Ventilator

A mechanically ventilated patient should not be switched to a portable ventilator at the last moment.

When possible, the patient should be connected to the transport ventilator approximately 5 to 10 minutes before departure. This allows the respiratory therapist to verify that the ventilator is functioning correctly and that the patient tolerates the settings.

The therapist should assess:

• Exhaled tidal volume
• Respiratory rate
• Peak inspiratory pressure
• PEEP
• Oxygen saturation
• Patient comfort
• Patient-ventilator synchrony
• Hemodynamic response

Note: Ventilator settings and the patient’s respiratory status should be documented before departure.

Securing the Artificial Airway

The endotracheal or tracheostomy tube must be secured before transport. A recently inserted endotracheal tube should have its position confirmed before movement. Tube depth should be documented, and fixation devices should be inspected.

Endotracheal tube cuff pressure should be checked before transport and reassessed after transport when appropriate.

During every major patient transfer, such as from a hospital bed to a stretcher or from a stretcher to an imaging table, the airway and all respiratory connections should be rechecked.

Manual Ventilation as a Backup

A manual resuscitation bag should accompany every mechanically ventilated patient. If the transport ventilator fails or the patient suddenly develops a serious patient-ventilator interface problem, manual ventilation may be required immediately.

The resuscitation device should be capable of delivering supplemental oxygen. If the patient depends on PEEP, an appropriate PEEP valve should be available.

When severe deterioration occurs and ventilator malfunction is suspected, disconnecting the ventilator and manually ventilating the patient can help determine whether the problem is related to the ventilator or the patient.

Limitations of Manual Ventilation

Manual ventilation can be lifesaving, but it is less consistent than mechanical ventilation.

Potential problems include:

• Excessive ventilation
• Inadequate ventilation
• Variable tidal volumes
• Variable respiratory rates
• Loss of PEEP
• Caregiver fatigue

Note: For this reason, a transport ventilator is generally preferred for mechanically ventilated patients when one is available and appropriate.

Suction and Airway Equipment

Portable suction should accompany patients who may require airway clearance.

An intubated patient should also have emergency airway equipment readily available. This may include a laryngoscope, blades, spare endotracheal tubes, stylets, syringes, a cuff manometer, masks, and airway adjuncts.

If the artificial airway becomes dislodged, the team must be able to provide bag-mask ventilation and perform emergency reintubation if necessary.

Common Transport Emergencies

The transport team should anticipate several possible emergencies.

Airway Obstruction or Dislodgment

An endotracheal tube may become obstructed, kinked, disconnected, or displaced during movement.

Possible warning signs include sudden hypoxemia, increased airway pressure, decreased tidal volume, reduced breath sounds, agitation, cyanosis, or loss of capnography. The airway should be assessed immediately, and manual ventilation may be required.

Ventilator Failure

Ventilator failure may result from battery depletion, oxygen supply failure, circuit disconnection, malfunction, or accidental setting changes. The respiratory therapist should provide manual ventilation immediately while the problem is identified and corrected.

Tension Pneumothorax

A tension pneumothorax can cause rapid respiratory and cardiovascular deterioration. Possible signs include increasing respiratory distress, hypotension, hypoxemia, tachycardia, increased airway pressure, and decreased breath sounds on the affected side.

Emergency decompression may be required depending on the circumstances.

Cardiac Arrest

Critically ill patients can experience cardiac arrest during transport. The team should be prepared to begin cardiopulmonary resuscitation and advanced life support. Appropriate medications and a defibrillator should be available for high-risk patients.

Transport to Magnetic Resonance Imaging

MRI environments require special precautions because the scanner produces a powerful magnetic field. Ferromagnetic objects can be pulled toward the scanner with great force and become dangerous projectiles.

Potential hazards include conventional oxygen cylinders, intravenous poles, scissors, stethoscopes, monitors, and ventilators. Only equipment approved or appropriate for the MRI environment should enter restricted areas.

MRI transport may require:

• MRI-compatible ventilators
• Nonferrous oxygen cylinders
• Compatible regulators
• Appropriate monitoring equipment
• MRI-safe connectors and accessories

Note: The transport team must verify compatibility before entering the MRI area.

Transport to Hyperbaric Therapy

Hyperbaric transport and treatment involve changes in ambient pressure that affect gas volume. According to Boyle’s law, gas volume decreases as pressure increases and increases as pressure decreases.

These pressure changes can influence ventilator function and delivered tidal volume. Ventilator adjustments may be required during hyperbaric therapy.

After leaving the chamber, the original ventilator settings may need to be restored to prevent excessive ventilation or lung overdistention.

Transporting Patients With Contagious Disease

Patient transport should be limited when a patient has a contagious illness, but some movement may still be medically necessary. The appropriate precautions depend on the route of transmission and may include masks, gowns, gloves, eye protection, or protective coverings.

The receiving department should be notified before arrival so appropriate infection-control procedures can be prepared.

If a patient under respiratory precautions requires manual ventilation, an appropriate filter may be placed on the expiratory side of the resuscitation device to reduce contamination.

Pediatric Transport

Children require transport equipment that matches their age and size.

A pediatric transport kit may include:

• Pediatric resuscitation medications
• Appropriately sized masks
• Self-inflating resuscitation bags
• Pediatric airway equipment
• Small endotracheal tubes
• Intraosseous access equipment

Transport ventilators used for small children must be capable of delivering appropriately small tidal volumes and higher respiratory rates.

For an intubated child weighing less than approximately 15 kg, the transport ventilator should be approved and capable of accurate pediatric ventilation.

ECMO Transport

Transporting a patient receiving extracorporeal membrane oxygenation requires an experienced team and extensive preparation.

Equipment may include a fully charged ECMO battery system, adequate oxygen supply, transport ventilator, cardiac monitor, defibrillator, intravenous medications, fluids, emergency clamps, connectors, and circuit supplies.

Responsibilities should be assigned before movement. One team member may focus primarily on the ECMO circuit while others manage the airway, ventilator, medications, monitoring, and physical movement of the patient.

During transport, the circuit, oxygen supply, battery level, hemodynamic status, and respiratory condition require continuous observation. At the destination, electrical power and gas supplies should be reconnected promptly.

Ground Transport

Ground ambulances are commonly used for interhospital transport. They are generally practical for shorter distances and often provide more room than aircraft. They also allow easier access to the patient during the trip.

Ground transport can be affected by traffic, road conditions, weather, vibration, and sudden vehicle movement. All equipment and the patient must be secured.

Ground transport is commonly efficient for distances within roughly 100 miles, although the actual decision depends on local conditions and clinical urgency.

Helicopter Transport

Helicopters can reduce travel time when road transportation would be slow or difficult. They may be useful for intermediate distances, difficult terrain, trauma scenes, or situations requiring rapid transfer.

However, helicopters create several challenges:

• Limited working space
• High noise levels
• Significant vibration
• Limited access to the patient
• Altitude-related pressure changes

Note: Alarms may be difficult to hear, which makes visual monitoring especially important.

Fixed-Wing Aircraft

Fixed-wing aircraft may be preferred for longer-distance transport.

They can provide faster travel over long distances and may produce less vibration than helicopters. However, transport to and from airports adds time, and changes in cabin pressure can affect both the patient and respiratory equipment. For very long or intercontinental distances, jet aircraft may be used.

Air Transport and Oxygenation

As altitude increases, barometric pressure decreases. This lowers the partial pressure of inspired oxygen. As a result, alveolar and arterial oxygen pressures may decrease during flight.

Even individuals with normal lungs can develop mild hypoxemia at moderate altitude. Patients with existing pulmonary disease may experience a more clinically important reduction.

An estimate of the equivalent oxygen requirement can be calculated using:

FiO₂ at altitude = FiO₂ at sea level × 760 ÷ barometric pressure at altitude

For example, if a patient requires an FiO₂ of 0.50 at sea level and the barometric pressure at altitude is approximately 565 torr:

0.50 × 760 ÷ 565 = approximately 0.67

This patient would require an FiO₂ of approximately 0.67 to maintain a similar inspired oxygen partial pressure. Patients already requiring very high oxygen concentrations may need additional PEEP or CPAP during flight.

Gas Expansion at Altitude

As altitude increases and atmospheric pressure decreases, trapped gases expand. This can affect several clinical situations. An endotracheal tube cuff may expand and increase pressure against the tracheal wall. Cuff pressure should therefore be monitored as altitude changes.

Gas trapped within a pneumothorax may also expand and worsen the condition. A known pneumothorax may require appropriate chest drainage before flight.

Gas in the stomach and intestines can expand as well, potentially causing discomfort or impaired diaphragmatic movement. Gastric decompression may be needed in selected patients.

Ventilator Performance at Altitude

Transport ventilators may behave differently as atmospheric pressure changes. Depending on the ventilator design, delivered tidal volume may increase or decrease at altitude. Some devices compensate automatically, while others require adjustment or recalibration.

The respiratory therapist should understand the manufacturer’s recommendations for altitude use.

Capnography may also be affected by changes in barometric pressure. Some devices can display falsely low end-tidal CO₂ values unless compensation or recalibration is performed.

Documentation During Transport

Transport documentation should provide a record of the patient’s condition before, during, and after transport.

Documentation may include:

• Pretransport vital signs
• Oxygen therapy
• Ventilator settings
• Airway status
• Monitoring parameters
• Medications
• Significant events
• Interventions
• Patient tolerance
• Condition on arrival

Note: When ambulation is performed, the date, time, duration, level of assistance, and patient tolerance should also be documented.

Arrival at the Destination

Transport is not complete until the patient has been safely transferred to the receiving team and connected to appropriate equipment. For a mechanically ventilated patient, the receiving ventilator should be prepared before transfer whenever possible.

After arrival, the clinician should reassess:

• Airway position
• Breath sounds
• Oxygen saturation
• Ventilator settings
• Exhaled tidal volume
• Airway pressures
• PEEP
• Vital signs
• Hemodynamic status

Note: The endotracheal tube should be checked for correct position and security. All intravenous lines, drainage systems, chest tubes, monitoring cables, and respiratory connections should also be inspected. A clear verbal report should be given to the receiving healthcare professional.

Importance of Repeated Equipment Checks

One of the simplest ways to reduce transport complications is to repeatedly check the connections between the patient and equipment. Connections should be reviewed before leaving, after every major transfer, and again after arrival.

This includes:

• Ventilator circuit connections
• Endotracheal tube security
• Oxygen tubing
• IV lines
• Chest tubes
• Drainage systems
• ECG leads
• Pulse oximeter probes
• Infusion pump tubing

Note: Many transport complications occur during transfers between surfaces rather than during the actual travel period.

Patient Transport Practice Questions

1. What is patient transport?
Patient transport is the movement of a patient within a healthcare facility or between healthcare facilities while maintaining necessary monitoring, respiratory support, and clinical care.

2. What is the primary goal of patient transport?
The primary goal is to maintain patient safety, oxygenation, ventilation, hemodynamic stability, monitoring, and required treatments throughout the movement.

3. What is intrahospital transport?
Intrahospital transport is the movement of a patient from one location to another within the same healthcare facility, such as from the ICU to radiology.

4. What is interhospital transport?
Interhospital transport is the movement of a patient from one healthcare facility to another, usually for specialized treatment or services that are not available at the sending facility.

5. What should be assessed before transporting a patient?
The patient’s vital signs, respiratory status, oxygenation, ventilation, hemodynamic stability, airway security, level of consciousness, pain, strength, and overall ability to tolerate movement should be assessed.

6. When should a critically ill patient generally not be transported?
A critically ill patient should generally not be transported when adequate oxygenation, ventilation, airway control, hemodynamic stability, or appropriate monitoring cannot be maintained during the trip.

7. Why is preparation important before patient transport?
Preparation helps ensure that all necessary equipment, oxygen, medications, monitoring devices, batteries, and emergency supplies are available and functioning before the patient leaves the controlled clinical environment.

8. Why can a transport checklist be useful?
A transport checklist can help prevent essential equipment or supplies from being forgotten, especially during interhospital transport where replacement items may not be readily available.

9. What should be done with transport equipment before departure?
All transport equipment should be checked for proper operation, battery charge, appropriate settings, alarm function, and adequate supplies before departure.

10. What should be done with rechargeable equipment before transport?
Rechargeable equipment should remain connected to electrical power as long as possible before departure so that batteries are fully charged.

11. Why should oxygen cylinder duration be calculated before transport?
Oxygen cylinder duration should be calculated to ensure that the patient has enough oxygen for the entire transport plus an appropriate safety reserve.

12. How much extra oxygen should generally be available for patient transport?
The oxygen supply should generally be sufficient for the expected transport time plus approximately 30 minutes of reserve, although larger reserves may be needed for interhospital transport.

13. Why is a Bourdon-type flowmeter useful during patient transport?
A Bourdon-type flowmeter can be used when the oxygen cylinder and flowmeter are positioned horizontally without affecting the indicated flow when backpressure is absent.

14. What is an important limitation of a Bourdon-type flowmeter?
A Bourdon-type flowmeter is not backpressure compensated, so increased downstream resistance may cause it to indicate a flow greater than the amount actually reaching the patient.

15. How should oxygen cylinders be secured during transport?
Oxygen cylinders should be placed in approved holders or carts and secured so that they cannot fall, roll, strike objects, or become dangerous projectiles.

16. Why should oxygen cylinders never be dropped or dragged?
Dropping or dragging a cylinder can damage the valve, stem, safety device, or cylinder body and may create a serious high-pressure gas hazard.

17. What monitoring should generally continue during transport of a critically ill patient?
Monitoring should generally include heart rate, respiratory rate, ECG, pulse oximetry, and noninvasive blood pressure, with additional monitoring as clinically indicated.

18. When should invasive blood pressure monitoring continue during transport?
Invasive blood pressure monitoring should continue when a hemodynamically unstable patient already has an arterial line or requires close blood pressure assessment during transport.

19. Why is capnography useful during transport?
Capnography provides continuous information about ventilation and can help identify changes in ventilation, airway problems, patient disconnection, or equipment malfunction.

20. What transport equipment should accompany a mechanically ventilated patient?
A mechanically ventilated patient should have an appropriate transport ventilator, oxygen supply, monitoring equipment, manual resuscitation bag, PEEP valve when needed, suction equipment, and emergency airway supplies.

21. Why should a manual resuscitation bag accompany a mechanically ventilated patient?
A manual resuscitation bag provides an immediate backup method of ventilation if the transport ventilator fails, the circuit becomes disconnected, or another serious ventilatory problem develops.

22. Why is a transport ventilator usually preferred over manual ventilation?
A transport ventilator provides more consistent tidal volumes, respiratory rates, PEEP, and ventilatory support while reducing the risk of provider fatigue and unintended hyperventilation.

23. When should a patient ideally be connected to the transport ventilator before departure?
The patient should ideally be connected to the transport ventilator approximately 5 to 10 minutes before departure so proper function and patient tolerance can be verified.

24. What should be assessed after connecting a patient to a transport ventilator?
The respiratory therapist should assess exhaled tidal volume, respiratory rate, airway pressure, PEEP, oxygen saturation, patient-ventilator synchrony, comfort, and hemodynamic response.

25. What should be done each time a mechanically ventilated patient is moved from one surface to another?
The airway, ventilator circuit, oxygen tubing, intravenous lines, drainage systems, monitoring cables, and other patient-equipment connections should be rechecked for security and proper function.

26. Why should the receiving department be contacted before transport?
The receiving department should be contacted to confirm that it is ready for the patient and that any required personnel, equipment, or monitoring systems are available.

27. Why should team roles be assigned before transporting a critically ill patient?
Assigning team roles helps ensure that the airway, ventilator, intravenous lines, drainage systems, monitoring devices, and patient movement are managed safely and efficiently.

28. What should be done if a patient becomes unstable during transport?
The transport team should immediately assess the cause, provide necessary respiratory or cardiovascular support, and stop or redirect the transport if needed.

29. What are common complications associated with transporting critically ill patients?
Common complications include hypoxemia, cardiovascular instability, artificial airway dislodgment, equipment failure, battery depletion, and loss of monitoring capability.

30. Why is airway security especially important during transport?
Airway security is critical because accidental displacement, obstruction, or disconnection of an artificial airway can rapidly impair ventilation and oxygenation.

31. What should be done with a recently inserted endotracheal tube before transport?
Its position should be confirmed, the tube should be securely stabilized, and its depth should be documented before transport begins.

32. Why should endotracheal tube cuff pressure be checked before and after transport?
Cuff pressure should be checked to help maintain an adequate airway seal while reducing the risk of excessive pressure on the tracheal wall.

33. What should be done if a serious patient-ventilator interface problem develops during transport?
The patient should be disconnected from the transport ventilator and manually ventilated with 100% oxygen, with PEEP added when required.

34. What is a major disadvantage of manual ventilation during transport?
Manual ventilation can produce inconsistent tidal volumes and respiratory rates and may result in unintended hyperventilation or loss of PEEP.

35. Why can manual ventilation become less reliable during a prolonged transport?
The healthcare provider may become fatigued, making it more difficult to maintain consistent ventilation over time.

36. What alarms are especially important on a transport ventilator?
Important alarms include high airway pressure, patient disconnection, low battery, gas supply failure, electrical supply failure, and ventilator malfunction.

37. Why should exhaled tidal volume be monitored during pressure-controlled ventilation?
Changes in lung compliance or airway resistance can alter the tidal volume delivered during pressure-controlled ventilation.

38. What could cause exhaled tidal volume to decrease during pressure-controlled ventilation?
Decreased lung compliance or increased airway resistance can reduce the tidal volume delivered at the same inspiratory pressure.

39. Why is portable suction equipment important during transport?
Portable suction allows secretions to be removed if airway obstruction or secretion retention develops while the patient is away from the bedside.

40. What emergency airway supplies should be available for an intubated patient during transport?
Emergency supplies may include a laryngoscope, blades, endotracheal tubes, stylet, syringe, cuff manometer, airway adjuncts, masks, and a manual resuscitation device.

41. Why should monitoring continue during every phase of patient transport?
Continuous monitoring allows the transport team to identify respiratory, cardiovascular, or equipment-related problems before they progress to severe deterioration.

42. What is the role of pulse oximetry during transport?
Pulse oximetry provides continuous information about arterial oxygen saturation and can help identify developing hypoxemia.

43. Why can visual monitoring become especially important during helicopter transport?
High noise levels can make audible alarms and auscultation difficult, so visual observation of monitors and alarm indicators becomes more important.

44. Why is transport to an MRI suite potentially hazardous?
The strong magnetic field can attract ferromagnetic equipment and turn incompatible objects into dangerous projectiles.

45. What type of oxygen cylinder should be used when transporting a patient into an MRI environment?
A nonferrous, MRI-compatible oxygen cylinder should be used in accordance with the facility’s MRI safety requirements.

46. Why must ventilators and monitors be checked for MRI compatibility?
Equipment containing unsafe magnetic materials can malfunction or be pulled toward the MRI scanner, creating a serious safety hazard.

47. How does increasing altitude affect barometric pressure?
Barometric pressure decreases as altitude increases.

48. How does altitude affect the partial pressure of inspired oxygen?
As altitude increases and barometric pressure falls, the partial pressure of inspired oxygen decreases.

49. Why may a patient require a higher FiO₂ during air transport?
A higher FiO₂ may be needed to compensate for the reduced inspired oxygen pressure that occurs at altitude.

50. What happens to trapped gas as atmospheric pressure decreases during ascent?
Trapped gas expands as atmospheric pressure decreases, which can affect structures such as endotracheal tube cuffs, pneumothoraces, and gas within the gastrointestinal tract.

51. Why should a pneumothorax be identified and treated before air transport?
A pneumothorax can enlarge as altitude increases because trapped gas expands when atmospheric pressure decreases, potentially worsening respiratory and cardiovascular compromise.

52. What may be required for a patient with a pneumothorax before air transport?
A functioning chest drainage system may be required to allow expanding pleural gas to escape and reduce the risk of deterioration during ascent.

53. Why may gastric decompression be needed before air transport?
Gas in the stomach and intestines can expand at altitude, causing discomfort, abdominal distention, and impaired diaphragmatic movement.

54. How can altitude affect endotracheal tube cuff pressure?
As altitude increases and atmospheric pressure falls, gas in the cuff can expand and increase pressure against the tracheal wall.

55. What should be done with endotracheal tube cuff pressure during air transport?
Cuff pressure should be reassessed as altitude changes to help prevent excessive tracheal pressure or loss of an adequate airway seal.

56. How can altitude affect transport ventilator performance?
Changes in atmospheric pressure can alter delivered tidal volume or other ventilator functions depending on the design of the device.

57. What should the respiratory therapist know about a transport ventilator before air transport?
The therapist should understand whether the ventilator compensates for altitude and whether recalibration or setting adjustments are required during flight.

58. How can altitude affect capnography readings?
Some capnometers may display falsely low end-tidal CO₂ values at altitude unless they compensate for changes in barometric pressure.

59. Why is pulse oximetry especially useful during air transport?
Pulse oximetry provides continuous assessment of oxygenation while inspired oxygen pressure may decrease as altitude increases.

60. What should be considered if a patient already requires a very high FiO₂ before air transport?
The patient may need additional PEEP or CPAP because increasing FiO₂ alone may not fully compensate for reduced oxygen pressure at altitude.

61. What is the formula used to estimate the FiO₂ needed at altitude?
FiO₂ at altitude = FiO₂ at sea level × 760 ÷ barometric pressure at altitude.

62. A patient requires an FiO₂ of 0.50 at sea level. What approximate FiO₂ may be required at a barometric pressure of 565 torr?
An FiO₂ of approximately 0.67 may be required.

63. Why is ground transport often useful for shorter interhospital distances?
Ground transport is generally economical, reliable, provides more working space than aircraft, and avoids some of the physiologic effects of altitude.

64. What factors can delay ground ambulance transport?
Traffic, road conditions, weather, construction, and other travel-related obstacles can delay ground transport.

65. What is an advantage of helicopter transport compared with ground transport?
Helicopters can bypass road traffic and difficult terrain and may reduce travel time in selected situations.

66. What are major disadvantages of helicopter transport?
Helicopter transport provides limited working space and exposes the patient and healthcare team to substantial noise, vibration, and altitude-related pressure changes.

67. Why can auscultation be difficult during helicopter transport?
High environmental noise can make breath sounds, heart sounds, and audible alarms difficult to hear.

68. When may fixed-wing aircraft be preferred for patient transport?
Fixed-wing aircraft may be preferred for longer-distance transport because they can provide faster travel over long distances with less vibration than helicopters.

69. What is one limitation of fixed-wing transport?
It requires access to airports and may involve additional ground transfers between the hospital and aircraft.

70. Why must patients and equipment be securely positioned during external transport?
Vehicle movement, vibration, acceleration, deceleration, and turbulence can cause unsecured patients or equipment to shift and create safety hazards.

71. Why are infants and children especially vulnerable during transport?
They are more susceptible to temperature changes, require size-appropriate equipment, and may need smaller tidal volumes, faster respiratory rates, and age-specific medications.

72. What should a pediatric transport kit contain?
It should contain age-appropriate resuscitation medications, a self-inflating bag, appropriately sized masks, airway equipment, and equipment for emergency vascular or intraosseous access.

73. What special requirement applies to a transport ventilator used for a small child?
The ventilator must be capable of accurately delivering small tidal volumes and the higher respiratory rates required by pediatric patients.

74. What is especially important when transporting an intubated child weighing less than 15 kg?
The transport ventilator should be approved for pediatric use and capable of accurately supporting the child’s ventilation requirements.

75. What should happen after a mechanically ventilated patient arrives at the destination?
The patient should be connected to appropriate bedside monitoring and ventilatory support, the airway and ventilator settings should be reassessed, and a complete handoff should be provided to the receiving team.

76. Why should the patient’s position be maintained as consistently as possible during transport?
Maintaining the patient’s usual therapeutic position can help preserve respiratory comfort, ventilation, oxygenation, and hemodynamic stability during movement.

77. Why may an upright or forward-leaning position help some patients with respiratory disease?
These positions can reduce the work of breathing and improve respiratory comfort in patients who are experiencing dyspnea.

78. What should be done with intravenous lines and drainage tubes before moving a patient?
They should be positioned close to the patient and secured to reduce the risk of accidental pulling, disconnection, or removal.

79. Why should the bed wheels be locked before transferring a patient?
Locking the wheels prevents unexpected bed movement and reduces the risk of falls or injury during transfer.

80. Why should the bed be placed in a low position before moving a patient?
A low bed position improves stability and can make transfers safer for both the patient and healthcare worker.

81. Why should a patient be encouraged to breathe normally during transfer or ambulation?
Calm, steady breathing can reduce unnecessary respiratory strain and may help prevent worsening dyspnea during movement.

82. What should be available when ambulating a patient who may become weak or short of breath?
A chair should be available nearby so the patient can sit quickly if symptoms or distress develop.

83. What signs should prompt concern during patient ambulation?
Changes in level of consciousness, skin color, breathing pattern, strength, pain, dizziness, shortness of breath, or overall tolerance should prompt concern.

84. Why is early ambulation encouraged when clinically appropriate?
Early ambulation can help reduce complications of prolonged bed rest, including atelectasis, pressure injuries, weakness, and loss of functional mobility.

85. How long may initial ambulation last in a patient who is just beginning to mobilize?
Initial ambulation may be limited to approximately 5 to 10 minutes and increased gradually as tolerated.

86. What information should be documented after ambulation?
The date, time, duration, level of assistance, patient tolerance, symptoms, and any significant physiologic response should be documented.

87. Why can transport be especially risky for a critically ill patient?
The patient may be temporarily separated from bedside resources, personnel, equipment, and immediate emergency support available in the ICU.

88. Why should a contingency plan be established before transport?
A contingency plan helps the team respond quickly if the patient deteriorates, equipment fails, the airway is lost, or emergency support is required.

89. Why should ventilator controls be protected during transport?
Protecting the controls helps prevent accidental changes to ventilator settings while the patient and equipment are being moved.

90. Why should ventilator displays remain visible during transport?
Visible displays allow clinicians to continuously evaluate settings, pressures, tidal volumes, alarms, and changes in ventilatory performance.

91. What should be done if a transport ventilator loses electrical or gas power?
The patient should be supported immediately with an available backup method, such as manual ventilation, while the source of the failure is corrected.

92. Why should alarm limits be established before transport?
Proper alarm limits help identify clinically important changes in the patient or equipment without unnecessary delay.

93. Why should suction equipment be battery powered or otherwise portable during transport?
Portable suction ensures that airway secretions can be removed even when wall suction is unavailable.

94. Why should a defibrillator accompany some critically ill patients during transport?
A defibrillator allows the team to respond immediately if a life-threatening arrhythmia or cardiac arrest occurs.

95. What supplies may be included in an ECMO transport emergency kit?
An ECMO transport emergency kit may include clamps, connectors, medications, intravenous fluids, and other supplies needed to manage circuit or patient emergencies.

96. What should be monitored continuously during ECMO transport?
The patient’s clinical status, extracorporeal circuit, battery level, gas supply, hemodynamics, and respiratory support should be monitored continuously.

97. What should be done promptly after an ECMO patient reaches the destination?
Electrical power and piped gas supplies should be reestablished as soon as possible.

98. Why should transport of a patient with a contagious disease be limited when possible?
Limiting unnecessary movement reduces the risk of exposing other patients, healthcare workers, and hospital areas to infectious organisms.

99. What infection-control measures may be required during transport of a contagious patient?
Depending on the route of transmission, measures may include masks, gowns, gloves, protective dressings, and other appropriate barrier precautions.

100. Why should the receiving team be notified before a patient on transmission-based precautions arrives?
Advance notification allows the receiving team to prepare the appropriate room, protective equipment, and infection-control measures before the patient enters the area.

Final Thoughts

Transporting a patient requires careful preparation because the patient may temporarily lose access to the resources normally available at the bedside. Safe transport depends on confirming clinical stability, securing the airway and medical devices, providing enough oxygen and battery power, using appropriate monitoring, preparing backup equipment, and assigning clear responsibilities to the transport team.

Mechanically ventilated and critically ill patients require especially close attention because respiratory deterioration can occur rapidly.

Whether transport occurs across the hospital or between facilities, continuous assessment and repeated equipment checks help maintain oxygenation, ventilation, hemodynamic stability, and patient safety throughout the journey.