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TRANSPORT OF

THE CRITICALLY ILL


PATIENTS

Dept/SMF Anestesiologi dan Terapi Intensif


FK USU/RSUP H. Adam Malik Medan

TRANSPORT OF PATIENTS
PRIMARY TRANSPORT
SECONDARY 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)

Primary versus Secondary Transport


Primary

Secondary

Location

Prehospital to Hospital Inter or Intrahospital

Purpose

Initial stabilization,
evacuation

Stabilization, definitive
care

Vehicle

Ground, Helicopter

Ground, Helicopter,
Plane

Patient

Potentially unstable

Stabilized

Time factor

Short response time


critical

Speed may be less


critical

Organization

EMS prehospital

EMS hospital -based

EMS : Emergency Medical Services

KEPUTUSAN MERUJUK
Keputusan Medik
Idealnya Dirujuk Ke RS Yang Lebih
Tinggi
Tahu Kemampuan RS Tujuan
Diusahakan Rujuk Ke RS Terdekat
Dilakukan Resusitasi Tanpa Menunggu
Keputusan Dari RS Rujukan

PRINSIP UTAMA DALAM RUJUKAN


JANGAN MEMBUAT CEDERA LEBIH
LANJUT PADA PENDERITA

* DO

NO FURTHER
HARM *

Rumah sakit

Pra rumah sakit

+
Pasien
gawat
darurat

Transportasi

+
Puskesmas
Praktek
swasta

+
Ruang
resusitasi
Kamar
bedah
ICU

RUJUKAN TERPADU

RS. KLAS A / B
PERAN UTAMA
TERAPI DEFENITIF BERAT
PENGEMBANGAN SDM

RS. KLAS C
PERAN
RESUSITASI
STABILISASI
TERAPI DEFENITIF SEDANG

RS. KLAS C

RS. KLAS C

PUSKESMAS PUSKESMAS PUSKESMAS


MODEL STRUKTUR SISKESNAS

SPGDT-S (Sistim Pelayanan Gawat Darurat Terpadu-Sehari2)


PENANGGULANGAN

PENCEGAHAN

MULTI DISIPLIN
ANTARA LAIN
- HELM
- SABUK
PENGAMAN

SUMBER DAYA MANUSIA

MULTI PROFESI
MULTI SEKTOR

YANG MEMBERI PERTOLONGAN


AWAM UMUM
PETUGAS
DOKTER
AWAM KHUSUS AMBULANS PERAWAT

TUJUAN
MENCEGAH
MASYARAKAT
AMAN /
SEJAHTERA
(SAFE COMMUNITY)

KOMUNIKASI

- KEMATIAN
- KECACADAN

TRANSPORTASI

++
PASIEN

AMBULANS PUSKESMAS RS.KLAS C

PRA RS

INTRA RS

RS. KLAS A/B

INTRA RS

ANTAR RS
PENDANAAN
TIME SAVING IS LIFE SAVING
RESPONSE TIME DIUPAYAKAN SEPENDEK MUNGKIN
MERUJUK THE RIGHT PATIENT, TO THE RIGHT PLACE AT THE RIGHT TIME

Sampaikan data
- fungsi vital
- Tx yang sudah
diberikan

RS penerima dapat
menyiapkan fasilitas
dan terapi lanjutan

20

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

Udara
ketinggian = tekanan udara, tekanan
O2
21

G-force

22

Pertahankan posisi korban tetap datar


selama diangkut
23

24

Atap tinggi
agar dapat bekerja
di dalamnya

Head-clearance tinggi
Petugas dapat memberi
pertolongan lanjutan
seraya ambulans jalan
25

Airway, Intubation, Suction


Neck Collar, sandbags
Oxygen, Ambu-bag, Ventilator
BP, infusion, bandages
Drugs (vasopressor)
EKG & DC shock
Stretcher, splint

26

Tanda
klinis
shock

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

27

Kalau ada ragu, kerjakan!


In doubt, do
Jalan nafas
intubasi
Pneumotoraks chest drain

28

Bawa cadangan Oksigen, Cairan perjalanan bisa tertunda


Jalan jangan terlalu cepat
Bila jalan menurun atau mendaki panjang, sesuaikan letak kepala
29

Jalan menurun
Gravitasi ke kepala
Aliran darah ke kepala
Tekanan Intra Kranial naik
30

Jalan mendaki
gravitasi ke kaki
Aliran darah ke otak
31

Air Medivac

Kabin bertekanan pada


pesawat komersial =
tekanan udara pada tinggi 3000m
= risiko hipoksia
33

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

34

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
Emergency & 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

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