The Importance of Ground Critical Care Transport.
Critical care transport (CCT) teams are specialized transport services, comprised of highly trained paramedics, nurses, and occasionally respiratory therapists, offering an expanded scope of practice beyond advanced life support (ALS) emergency medical service teams. We report 4 cases of patients with severe acute respiratory distress syndrome from influenza in need of extracorporeal membrane oxygenation evaluation at a tertiary care center, transported by ground. Our medical center did not previously have a ground CCT service, and therefore, in these cases, a physician and/or a respiratory therapist was sent with the paramedic team. In all 4 cases, the ground transport team enhanced the intensive care provided to these patients prior to arrival at the tertiary care center. In 2 of the cases, although limited by the profound hypoxemia, the team decreased the pressures and tidal volumes in an effort to approach evidence-based ventilator goals. In 3 cases, they stopped bicarbonate drips being used to treat mixed metabolic and respiratory acidosis, and in 1 case, they administered furosemide. In 1 case, they started cisatracurium, and in 3 others, they initiated inhaled epoprostenol. Existing literature supports the use of CCT teams over ALS teams for transport of the most critically ill patients, and helicopter CCT is not always available or practical. Therefore, offering comparable air and ground options, with similar staffing and resources, is a hallmark of a mature medical system with an integrated approach to CCT.
1 Division of Pulmonary, Critical Care, Allergy and Sleep Medicine, Division of Emergency Medicine, Medical University of South Carolina, Charleston, SC, USA.
Susan R
SR
Wilcox
2 Meducare Ground Transport, Medical University of South Carolina, Charleston, SC, USA.
Michael
M
Ries
2 Meducare Ground Transport, Medical University of South Carolina, Charleston, SC, USA.
Ted A
TA
Bouthiller
2 Meducare Ground Transport, Medical University of South Carolina, Charleston, SC, USA.
E Dean
ED
Berry
2 Meducare Ground Transport, Medical University of South Carolina, Charleston, SC, USA.
Travis L
TL
Dowdy
2 Meducare Ground Transport, Medical University of South Carolina, Charleston, SC, USA.
Sharon
S
DeGrace
D000328:Adult; D017732:Air Ambulances; D003422:Critical Care; D016638:Critical Illness / Q000628:therapy*; D004632:Emergency Medical Services; D015199:Extracorporeal Membrane Oxygenation / Q000379:methods*; D005260:Female; D006801:Humans; D000860:Hypoxia / Q000209:etiology / Q000628:therapy; D053118:Influenza A Virus, H1N1 Subtype / Q000472:pathogenicity*; D007251:Influenza, Human / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D008297:Male; D012128:Respiratory Distress Syndrome / Q000175:diagnosis / Q000628:therapy* / Q000821:virology; D014187:Transportation of Patients; D014665:Vasodilator Agents / Q000008:administration & dosage*
D014665:Vasodilator Agents
critical care; intensive care; interhospital transfer; mechanical ventilation; organizational factors; resource allocation