Preparation of patients for safe transport
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Transport of any patient is potentially dangerous, and the risks of transport / transfer must always be taken into account when such decisions are being taken. A planned and measured approach prior to a transfer should make the transfer uneventful.
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An aircraft is not an appropriate place for a birth to occur. Transport may be appropriate if labour is suppressed; otherwise it may be more appropriate to deliver the baby locally and transport mother and baby as required.
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The safety of aerial transfer must be determined in consultation with the flight coordination staff at Air Ambulance Victoria (AAV); the decision not to fly is always the pilot's prerogative and must always be listened to.
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The Perinatal Emergency Referral Service (PERS) is not designed to supplant current effective local Level I to Level II networks for consultation and referral purposes; it is designed to deal with questions of possible transfer to Level III maternity / neonatal facilities.
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All patients must be adequately prepared and stabilised prior to transport. In many cases this can be done prior to arrival of the transport team.
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Documentation is required by the transport team and by the receiving facility in order to provide appropriate ongoing care. The chain of responsibility must be clear throughout transfer. Formal handover from referring team to transport team, and from transport team to receiving team is essential. The transport team should communicate with the PERS consultant if the clinical condition of the patient changes en route.
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Lateral tilt for supine pregnant women is critical over long journeys; whilst maternity unit staff will recognise this need it is wise to reinforce such a need for careful patient positioning to non-obstetric non-midwifery personnel.
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All patients in whom intravenous access is likely to be required during transfer should have one or two (depending on the clinical situation) venous cannulae inserted and secured prior to transfer. Any needed infusions should be prepared prior to transport and labelled accurately. AAV currently utilise syringe pumps for infusions with additives and any preparations should be drawn up into 50 ml syringes and labelled accordingly.
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All patients should be asked to empty their bladder prior to transfer; consideration should be given to inserting an indwelling catheter in the event of aerial transfer of patients with a significant anticipated intravenous fluid intake.
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Parenteral administration of an antiemetic should be considered if there is a past history of motion sickness, or if the current condition of the patient is associated with significant risk of vomiting (eg. bowel obstruction). A nasogastric tube should be inserted prior to transport if active vomiting is not suppressed by the antiemetic.
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Anaemia reduces the oxygen carrying capacity of the blood; this is exacerbated at altitude due to the reduced partial pressure of oxygen. Patients with a haemoglobin concentration less than 7g/dL should ideally be transfused prior to transfer.
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