Departemen/SMF - Anestesi dan Terapi Intensif FK USU/RSUP H.

Adam Malik Medan

TRANSPORT OF PATIENTS
PRIMARY TRANSPORT SECONDARY TRANSPORT AIR TRANSPORT NEONATAL TRANSPORT

PEDIATRIC TRANSPORT

PRIMARY TRANSPORT
The management and transport of a patient from an accident side to the closest available adequate medical facility.

THE EARLIEST , THE BETTER

SECONDARY TRANSPORT
When the patient needs to be transferred to a second hospital or has to be moved within the same hospital to a different site (e.g. from the Intensive Care Unit to the Scanner Room)

Air Medivac

Primary versus Secondary Transport

Primary
Location Purpose Vehicle Patient Time factor Organization Initial stabilization, evacuation Ground, Helicopter Potentially unstable

Secondary
Stabilization, definitive care

Prehospital to Hospital Inter or Intrahospital

Ground, Helicopter, Plane

Stabilized

Short response time critical

EMS prehospital

Speed may be less critical

EMS hospital -based

EMS : Emergency Medical Services

Sampaikan data - fungsi vital - Rx yang sudah diberikan

RS penerima dapat menyiapkan fasilitas dan terapi lanjutan

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JENIS TRANSPORTASI
Darat
jarak & lama permukaan rata / kasar kemiringan dan arah trayek

Udara
ketinggian = tekanan udara, tekanan O2
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G-force

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Pertahankan posisi korban tetap datar selama diangkut

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Atap tinggi agar dapat bekerja di dalamnya

Head-clearance tinggi Petugas dapat memberi pertolongan lanjutan seraya ambulans jalan
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Airway, Intubation, Suction Neck Collar, sandbags Oxygen, Ambu-bag, Ventilator BP, infusion, bandages Drugs (vasopressor) EKG & DC shock Stretcher, splint

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Tanda klinis shock

Nafas cepat Kulit dingin, pucat, basah, sianosis Capillary refill time > 2 detik

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Kalau ada ragu, kerjakan! In doubt, do Jalan nafas intubasi Pneumotoraks chest drain
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Bawa cadangan Oksigen, Cairan perjalanan bisa tertunda Jalan jangan terlalu cepat Bila jalan menurun atau mendaki panjang, sesuaikan letak kepala
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Jalan menurun Gravitasi ke kepala Aliran darah ke kepala Tekanan Intra Kranial naik
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Jalan mendaki gravitasi ke kaki Aliran darah ke otak

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Minimum Equipment that shall be available

For Airway and Ventilatory Management:
Oxygen source

Suction apparatus and Catheters Cardiac Monitor/Defibrillator Blood Pressure Cuff Pulse Oxymetry Materials for IV therapy: cannulas, solutions, tubing, needles and syringe Drugs for advanced Cardiac Resuscitation

Monitoring during transport:

Continuous EKG monitoring Intermittent measurement of: Blood Pressure Respiratory Rate Continuous monitoring by Pulse Oximetry is strongly recommended Intubated patients receiving mechanical support of ventilation should have airway pressure monitored

Standard Resuscitation Drugs

Sulfas Atropine Epinephrine Dobutamin Lidocaine Sodium Bicarbonat Muscle Relaxant Sedative Dexamethasone

Risk to the patient during transport can be minimized :

Careful Planning Use of appropriately qualified Personnel Selection of appropriate equipment The available equipment and skill level of the accompanying personnel must be equal to the interventions or anticipated for the patient

Personnel who accompany the patient: A minimum of two people shall accompany the patient : Physician Critical Care Nurse

The Basic Reason for Moving a Critically Ill Patient is :

The need for additional care Technology Specialists Nurse not available at the patients current location
Society of Critical Care Medicine: Guidelines for the Transfer of Critically Ill Patients. Crit Care Med 1993 June,21(6):931-937

Dalam helikopter banyak gangguan suara dan gelombang elektromagnetik

Terbang ketinggian > 3000 m tanpa kabin bertekanan | risiko hipoksia

Perubahan tekanan = risiko: - udara dalam botol infus - udara dalam pneumothorax - letak botol WSD

Kabin bertekanan pada pesawat komersial = tekanan udara pada tinggi 3000m = risiko hipoksia

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Kabin bertekanan pada pesawat komersial = tekanan udara pada tinggi 3000m = risiko hipoksia
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Tulonnngggggggg Gue masih pengen Hidup . . . . . .

Thank you for your Attention