Final preparation of the patient should be made before the actual move, with conscious anticipation of clinical needs. Patients should be appropriately resuscitated and stabilised prior to transfer in order to reduce the physiological disturbance associated with movement and reduce the risk of deterioration during the transfer9. Examples include giving appropriate doses of muscle relaxants or sedatives, replacing near-empty inotropic and other intravenous (IV) solutions with fresh bags, and emptying drainage bags.
The patient will need to be “packaged” prior to retrieval.
The packaging procedure aims to:
· Minimise clot disturbance and repeated blood loss by reducing patient movement, application of pelvic binder or limb splints and limiting repeated log rolls.
· Minimise spinal movements.
· Minimise cytokine release.
· Maintain normothermia.
· Prevent pressure induced skin injuries.
Vacuum mats will often be used to facilitate this.
Haemostatic packaging is based on the concept of “First clot is best” with any further bleeding depleting coagulation factors and resulting in worse patient outcomes10.
The patient must be reassessed before transport begins, especially after being placed on monitoring equipment and the transport ventilator (if used). Transport preparations must not overshadow or neglect the patient’s fundamental care.