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Table 1 Patient transport issues and solutions for COVID-19

From: Safe patient transport for COVID-19

 Intra-hospital transportInter-hospital transport
Transport from EMD to GW or ICU; transport from GW to ICUTransport for radiology scansFor advanced ICU services, e.g. ECMO
Patient safety• Early transfer of deteriorating cases to ICU• To minimise need for scans, e.g. using bedside ultrasound• Early transfer of deteriorating cases
• Clear thresholds for transfer and workflows for non-ECMO centres
• For deteriorating patients, to assess the need for intubation prior to transport
• To be accompanied by at least a doctor and a nurse who are able to handle emergencies during transport
• Continuous monitoring of parameters (blood pressure, pulse rate, pulse oximetry)
• Continuous end-tidal CO2 monitoring in intubated patients
• Transport monitor should be equipped with defibrillation function or else a separate defibrillator is needed
Safety of HCW and transport staff• All transport staff should be mask-fitted for N95 respirators
• All transport staff to don full PPE prior to transport
• To put on surgical mask for patient during transport
• To avoid using open breathing circuits, or high-flow nasal oxygenation and non-invasive positive pressure during transport
• To add on HEPA filters to endotracheal tubes if bagging is required via BVM
• To add on HEPA filters to expiratory limbs of the breathing circuits for ventilators
• Avoid unnecessary breathing circuit disconnection during transport
• Scans to be performed at the end of the day if possible, to allow for terminal cleaning of radiology
• All transport staff should be mask-fitted for N95 respirators and trained to use PAPRs
• All transport staff to don full PPE and PAPRs prior to transport
• To bring along spare battery packs for PAPRs
• To add on HEPA filters to endotracheal tubes if bagging is required via BVM
• To add on HEPA filters to expiratory limbs of the breathing circuits for ventilators
• Minimise endotracheal tube disconnections during transport
• To wind down ambulance windows if possible
Bystander safety• To use a pre-planned dedicated transport route to each destination
• Security team to lead and ensure clearance of bystanders for the entire designated route ahead of transport team. Security team should wear surgical masks
Rescue and contingency plans during transport• To assess the need for intubation prior to transport. Intubation is best done in ICU under controlled settings with the intubating physician wearing PPE and using a PAPR
• Prepare transport equipment and drugs in anticipation of medical emergencies, such as sudden cardiovascular collapse or hypotension
• Gentle bagging by BVM to reduce aerosolization in the event of worsening hypoxemia. BVM should be fitted with HEPA filter
Post-transport
decontamination
• Dedicated housekeeping team in PPE to perform terminal cleaning of dedicated route and elevator right after transport
• Staff to doff PPE appropriately after transport
• Dedicated housekeeping team in PPE to perform terminal cleaning of dedicated route and elevator right after transport
• Staff to doff PAPRs and PPE at destination after transport
• PAPRs to be wiped down and disinfected using alcohol wipes
• Staff to don new PPE for the return journey prior to embarking on the same ambulance
• Staff to doff PPE in the nearest clinical area, for example ambulance bay, upon arrival
• Terminal cleaning of ambulance upon arrival when back at primary hospital
  1. BVM bag-valve-mask, CO2 carbon dioxide, ECMO extracorporeal membrane oxygenation, EMD emergency, GW general ward, HEPA high-efficiency particulate air, ICU intensive care unit, PAPR powered air-purifying respirator, PPE personal protective equipment