Guide — Transport Respiratory Care
Pre-Transport Assessment & Preparation
Most transport disasters are prevented on the unit, before anyone moves. This guide builds the systematic pre-transport routine: confirm the destination and the plan, package the patient by ABCs plus equipment, stabilize first, and run the checklist that the evidence says reduces adverse events.
7 min read · Transport Respiratory Care
Written by Apex Respiratory Editorial Team
Educational use only. This material supports respiratory therapy education and exam review. It is not medical advice and is not a substitute for clinical judgment, institutional protocols, or physician orders. Always follow facility policies and current provider orders, and verify calculations independently before clinical use.
Overview
Pre-transport preparation is where transport safety is won. The goal is to leave the unit with a stabilized, fully packaged patient and a contingency plan — not to stabilize en route. Unplanned deterioration during transport is common and disproportionately dangerous: the environment is confined, personnel are limited, and backup resources are absent. Structured preparation and checklists measurably reduce transport adverse events and are the standard of care endorsed by the American College of Critical Care Medicine.
The respiratory therapist plays a central role in pre-transport packaging — owning the airway, breathing, and oxygen supply components of the ABC framework and ensuring every device is charged and verified before the team leaves the floor.
Key Concepts
Two decisions anchor every transport: is this the right time to move? and is the team ready to manage any predictable deterioration? Both require structured communication before departure.
- Risk-benefit decision. Transport exposes the patient to real physiologic risk. The benefit of the study, procedure, or destination must be documented to outweigh that risk before departure is authorized.
- Confirm the receiving side. A named accepting provider, a confirmed bed, and a ready receiving team are non-negotiable. Arriving at an unprepared destination compounds any deterioration.
- Documentation and consent. Relevant records, current medication list, and consent (where required) must travel with the patient.
- Minimum trained personnel.At least two trained team members must accompany a critically ill patient — one to manage the patient, one to manage equipment and logistics.
- Contingency plan. The team should agree before departure on the response to the most predictable forms of deterioration (e.g., tube displacement, desaturation, hypotension) and on the nearest safe abort point.
Assessment & Findings
Package the patient systematically using the ABC + Drugs + Equipment framework. Each component must be verified before departure, not assumed.
| Component | What to Verify Before Departure |
|---|---|
| Airway | Tube secured, position confirmed with capnography; suction device and backup airway ready. |
| Breathing | Ventilator settings set and verified; O₂ supply calculated for round trip + reserve; bag-valve device present. |
| Circulation | Two reliable IV access points; vasoactive infusions on pumps with charged batteries; monitor attached. |
| Drugs | Emergency medications available; sedation and analgesia running continuously. |
| Equipment | Every battery-powered device checked and charged; defibrillator or monitor as indicated. |
Oxygen supply calculation is mandatory. Calculate the O₂ requirement for the full round trip plus a minimum 30–minute reserve before leaving the unit. An uncalculated or marginally sufficient supply is one of the most preventable causes of transport-related hypoxemia.
RT Priorities & Interventions
- Stabilize before departure. Optimize oxygenation (SpO₂ and FiO₂), ventilation (PaCO₂ trend, ETCO₂), and hemodynamics before the team leaves the unit. If the patient cannot be stabilized, departure should be delayed or the risk-benefit decision revisited.
- Calculate oxygen supply during preparation. Do not defer the calculation to the hallway or the elevator. Account for current flow rate, anticipated duration, and round-trip distance plus reserve.
- Verify all airway and breathing equipment. Confirm tube security and position with capnography, have suction immediately accessible, and ensure a backup bag-valve-mask device is charged and functional.
- Confirm all device batteries. Ventilator, infusion pumps, monitor, and defibrillator batteries must be fully charged. A device that dies mid-transport creates an immediate emergency.
- Brief the team and assign roles. Rehearse the contingency plan for the most likely forms of deterioration. Every team member should know their role before the patient is moved.
- Use a written checklist. Complete the pre-departure checklist in sequence. Do not substitute verbal review or memory for a documented, checked list.
Common Pitfalls
- Departing with marginal stability.Time pressure — from the receiving team, the scheduling department, or the transporting team — frequently drives premature departure. Marginal oxygenation or borderline hemodynamics that appear acceptable on the unit are amplified in transport.
- Inadequate or uncalculated oxygen supply. Assuming the tank is full, or estimating rather than calculating, is a recurring cause of transport hypoxemia.
- Uncharged equipment batteries. Battery failures are the single most common equipment-related adverse event during transport and are entirely preventable during preparation.
- Unsecured lines and tubes. IV lines, ETT, and drainage tubes that are not secured before transport are at high risk of displacement during patient movement.
- No contingency plan. Transport without a predefined response to predictable deterioration leaves the team improvising in a constrained environment where every second counts.
- Skipping or rushing the checklist. Verbal substitution for a written checklist allows critical steps to be missed without detection.
Board Exam Pearls
- Stabilize before transport, not during. Departure with marginal stability is a recognized cause of transport adverse events; the ACCM guidelines are explicit on this point.
- Calculate O₂ supply (round trip + reserve) as a required preparation step, not an afterthought. The Oxygen Tank Duration calculator supports this calculation.
- Minimum two trained personnel must accompany any critically ill patient during inter- or intrahospital transport.
- Checklists reduce transport-related adverse eventsby preventing equipment failures and missed steps — the evidence supports their mandatory use.
- Capnography confirms airway position before and during transport; it is the preferred method over clinical assessment alone.
FAQ
What must be confirmed before the team leaves the unit?
Confirm the receiving unit, an accepting provider, and that a bed is ready. Verify that documentation and consent are complete and that the risk-benefit ratio favors moving the patient at that moment. No transport should begin without a confirmed destination and a handoff plan.
How do you package a critically ill patient for transport?
Work through ABCs plus drugs and equipment. Airway must be secured and position-confirmed with capnography, suction at hand. Breathing: ventilator settings verified, oxygen supply calculated for the round trip plus reserve, backup bag-valve device present. Circulation: two reliable IV sites, pumps running on charged batteries, monitor attached. Drugs: emergency medications available, sedation and analgesia continued uninterrupted. Equipment: every battery-powered device fully charged, defibrillator or monitor as indicated.
Why must the patient be stabilized before departure rather than en route?
Transport environments are resource-constrained: confined space, limited personnel, reduced access to the patient, and no backup team. Deterioration is far harder to manage outside the unit. Optimizing oxygenation, ventilation, and hemodynamics before departure keeps the team in a controlled setting where interventions are fastest and safest.
How does a pre-transport checklist reduce adverse events?
Checklists externalize memory, enforce a fixed sequence, and create a shared mental model for the whole team. Evidence shows they reduce equipment failures, missed steps, and communication errors -- the three most common contributors to transport-related adverse events. A written checklist, completed before departure, is more reliable than verbal review alone.
Put it to work
Oxygen is the one supply you cannot improvise mid-trip. Calculate it during prep with the Oxygen Tank Duration calculator.
Open the Oxygen Tank Duration calculator →Related Resources
Sources
- Warren J, Fromm RE Jr, Orr RA, Rotello LC, Horst HM; American College of Critical Care Medicine. Guidelines for the inter- and intrahospital transport of critically ill patients. Crit Care Med. 2004;32(1):256-262.
- Droogh JM, Smit M, Absalom AR, Ligtenberg JJ, Zijlstra JG. Transferring the critically ill patient: are we there yet? Crit Care. 2015;19(1):62.