Table 1 Patient transport issues and solutions for COVID-19
| Â | Intra-hospital transport | Inter-hospital transport | |
|---|---|---|---|
Transport from EMD to GW or ICU; transport from GW to ICU | Transport for radiology scans | For 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 | |