Time to get going?

Critical Care Patient TransferOk. So now you are actually just about to get your patient in the ambulance and do your patient transfer. You have done all your checks. What could possibly go wrong?

Plenty!! If you are not careful.

There are still many things you need to be aware of.

Secure Patient and Yourself.

The first job is to get the patient and then you in a comfortable and safe position. Its likely that you have just gone through the corridors of the hospital to the waiting ambulance and it might be wise before you push up that ramp, or the tailgate lift to have another quick visual sweep to ensure that no lines have come loose, which may catch on something, or that you have not dropped something on the way down.

Ensure that you are happy that the trolley has locked securely into place. Our ambulance colleagues are wonderful people, but I am sure even they wouldn’t mind an extra pair of eyes when checking such things.

If you are really lucky you might have a proper transfer trolley as in the picture to the right. Critical Care Patient TransferOn it you will be able to mount all your pumps and monitor and ventilator properly and safely. If you don’t have one, then I would start waving various guidelines from esteemed societies at your managers and using the words ‘patient safety’ at them. That should do it!

If you don’t have such a trolley, but instead are using the standard ambulance trolley, then getting yourself settled into the ambulance becomes very important. NOTHING must be left on the patient. Do not be tempted to squeeze the infusion pumps between the patients legs, or balance the monitor against the side of the patient.

Firstly you need easy access to all this equipment, and hidden under blankets is not the best place for them to be. Secondly, and more importantly, all these pieces of equipment will be lethal missiles if the ambulance swerves or brakes suddenly!

You must make those potentially lethal weapons as secure as possible before you start. On the floor of the ambulance is probably the best place for them, and if they can be stored under the trolley whilst still being accessible then I think that is the best alternative. Wedging them with your feet might be another idea. All sounds a bit dodgy I know but from experience if this is the trolley they give you then you have to make the best of things.

Don’t forget the oxygen!

Remember that you have been using the oxygen cylinder up until this point. You now need to switch them over to the ambulance supply at the first available chance. This point will usually be above the patients left shoulder on UK ambulances. Just like you would elsewhere make sure it connects properly and once in give it a tug test. When you have done that check your ventilator to ensure it is happy and check the patient to make sure the chest is rising and falling. Keep an ear out for that sats monitor for the next few minutes just in case!

Drugs and Drips?

Do you know where that important stock of pre-made up drugs have gone. Is it still in your sweaty palms or have you put it down somewhere? If so where? Make sure you have easy access to them and if you have any drips which you want access to or you feel need to keep infusing then get them hung up securely somewhere. You don’t want to be getting up because you didn’t make sure it couldn’t come loose.

Wheres my Suitcase?

We all seem to end up wheeling around huge bags of ‘stuff’ with us for just about every eventuality. As you have brought it along do you know where it is? Do you know how to get into it if you need to? Which compartment is the equipment you need? Probably should check this LONG before you get in the ambulance. Is it stowed away well- in other words it won’t kill you in the event of an accident but you can still get to the things you need.

Find your own Seat

Where do you want to be- possibly towards the head end. In a UK ambulance you can usually sit either right at the patients head-going backwards- or by their side. I have no real preference, but I would suggest that if you get ambulance sick (which I do sometimes) then sitting side on might be best.

PUT YOUR SEAT BELT ON!

Ready….Steady…..

Ok. Patient sorted. Everything as safe as you can make it. All equipment/drugs to hand. Next thing to do is to give the ambulance tech who is driving my favourite way of describing how I want the journey to go. I want blues and twos, don’t drive like a lunatic but MAKE PROGRESS. In other words drive normally and use the siren and lights to get us through traffic.

GO!…….

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Jevon

Jevon

Possibly the book I most highly recommend for nurses to use as their pocket guide. Phil Jevon is a practitioner in Walsall and has produced an easily read, pocket sized tool. You can click on the picture above  to purchase this excellent book.
Talley and O'Conner
Slightly less 'weighty' than Macleods but still with lots of useful detail and information. The latest copies also have a CD with good, well narrated examples of clinical examination.
Macleods
This title is 'Highly Commended' in the 2006 British Medical Association Awards! 'an incredibly thorough book which is very well illustrated - a must in a book explaining how to perform examinations' - ("Medical Student Review"). This book will show you how to: talk with a patient; take the history from the patient; examine a patient; formulate your findings into differential diagnoses and rank these in order of probability; and, use investigations to support or refute your differential diagnosis.