Transportation of Injured Persons
Comprehensive Nursing Notes
Professional emergency medical transportation with proper spinal immobilization techniques
Table of Contents
- Introduction and Overview
- Primary Assessment and Scene Safety
- Spinal Immobilization Techniques
- Transfer Methods and Equipment
- Special Situations and Considerations
- Nursing Roles and Responsibilities
- Transport Modes and Decision Making
- Documentation and Communication
- Complications and Management
- Quality Improvement and Best Practices
Introduction and Overview
The transportation of injured persons represents a critical component of emergency medical care that directly impacts patient outcomes. This process encompasses the systematic assessment, stabilization, and safe transfer of trauma patients from the point of injury to appropriate medical facilities. The principles of trauma transportation have evolved significantly, incorporating evidence-based practices that prioritize patient safety while minimizing secondary injury during transport.
Key Learning Objective:
Master the fundamental principles of safe patient transportation, including assessment techniques, immobilization strategies, and nursing interventions that optimize patient outcomes during emergency transport situations.
TRANSPORT Mnemonic
- T – Triage and assess severity
- R – Rapid stabilization
- A – Airway management
- N – Neurological assessment
- S – Spinal immobilization
- P – Positioning and padding
- O – Oxygen and vital signs
- R – Rapid transport decision
- T – Team communication
Historical Perspective and Current Standards
The evolution of trauma transportation began with military applications during World War I and has progressively advanced through decades of research and technological innovation. Modern transportation protocols are guided by organizations such as the American College of Surgeons, the National Association of Emergency Medical Technicians, and the International Association of Fire Chiefs.
Contemporary standards emphasize the “Golden Hour” concept, which suggests that critically injured patients have the highest survival probability when definitive care is provided within 60 minutes of injury. However, recent research has refined this concept to acknowledge that the optimal transport decision depends on injury severity, available resources, and the specific clinical presentation of each patient.
Primary Assessment and Scene Safety
The primary assessment forms the foundation of all transportation decisions. This systematic evaluation follows the ABCDE approach (Airway, Breathing, Circulation, Disability, Exposure) while maintaining constant awareness of scene safety and mechanism of injury. The assessment must be rapid yet thorough, identifying life-threatening conditions that require immediate intervention before and during transport.
Primary Assessment Flow
Environment, hazards, PPE requirements
High vs. low energy, penetrating vs. blunt
Life-threatening assessment
Load and go vs. stay and play
Scene Safety Protocols
Scene safety assessment begins before patient contact and continues throughout the emergency response. Healthcare providers must evaluate environmental hazards, traffic patterns, structural stability, and potential violence. The scene assessment determines personal protective equipment (PPE) requirements and influences the urgency of patient extraction.
Critical Safety Reminder:
Never compromise rescuer safety for patient access. A second casualty does not improve patient outcomes and may worsen the overall situation. Always establish scene control before beginning patient assessment.
Mechanism of Injury Assessment
Understanding the mechanism of injury provides crucial information about potential injuries and guides assessment priorities. High-energy mechanisms (falls >20 feet, motor vehicle crashes >40 mph, pedestrian vs. vehicle) suggest higher probability of serious internal injuries requiring rapid transport.
High-Risk Mechanisms:
- Motor vehicle crashes with significant deformity
- Falls from height greater than 20 feet
- Penetrating trauma to torso, neck, or head
- Crush injuries with prolonged extrication time
- Blast injuries from explosions
Spinal Immobilization Techniques
Spinal immobilization represents one of the most critical aspects of trauma patient transportation. The goal is to maintain anatomical alignment of the cervical, thoracic, and lumbar spine while preventing secondary injury during movement and transport. Modern protocols emphasize selective spinal immobilization based on clinical criteria rather than universal application.
SPINAL Criteria for Immobilization
- S – Significant mechanism of injury
- P – Point tenderness over spine
- I – Intoxication or altered mental status
- N – Neurological deficits present
- A – Age >65 years with concerning mechanism
- L – Loss of sensation or movement
Cervical Spine Immobilization
Cervical spine immobilization begins immediately upon patient contact and continues throughout transport. The technique involves maintaining the head in a neutral position aligned with the body axis. Manual stabilization is applied first, followed by mechanical immobilization using appropriate devices.
Manual Cervical Stabilization Technique:
- Approach from behind or beside the patient
- Place hands on both sides of the head
- Support the occiput and mandible
- Maintain neutral alignment
- Avoid excessive pressure on neck structures
Long Spine Board Application
Long spine boards provide full-body immobilization for patients with suspected spinal injuries. The application requires coordinated team effort using specific techniques such as the logroll or scoop stretcher method. Proper padding and securing are essential to prevent pressure injuries and maintain immobilization effectiveness.
Logroll Technique Steps
Leader at head, 2-3 assistants at body
Coordinated grip on shoulder, hip, legs
Leader counts, team moves as unit
Slide board under patient body
Alternative Immobilization Devices
Modern practice increasingly utilizes alternative devices such as vacuum mattresses, scoop stretchers, and specialized cervical collars. These devices offer advantages in patient comfort, ease of application, and clinical effectiveness while maintaining the primary goal of spinal immobilization.
Immobilization Equipment Options:
- Rigid Cervical Collars: Size-appropriate, proper fit essential
- Head Immobilization Devices: Blocks, straps, tape systems
- Vacuum Mattresses: Conforming support, reduced pressure points
- Scoop Stretchers: Minimal patient movement required
- Pediatric-Specific Devices: Age and size-appropriate options
Transfer Methods and Equipment
Effective patient transfer requires systematic planning, appropriate equipment selection, and coordinated team execution. The method chosen depends on patient condition, injury pattern, environmental constraints, and available resources. Each transfer technique carries specific indications, advantages, and potential complications that must be considered.
Emergency Moves
Emergency moves are performed when immediate life threats exist, such as fire, explosion risk, or structural collapse. These moves prioritize rapid extraction over ideal spinal immobilization, accepting increased risk to prevent greater harm. The urgency of the situation determines the specific technique employed.
EMERGENCY Move Indications
- E – Environmental hazards present
- M – Medical emergency requiring immediate access
- E – Explosion or fire risk
- R – Respiratory or cardiac arrest
- G – Gas leaks or toxic exposure
- E – Electrical hazards active
- N – Need to access other patients
- C – Collapse potential of structures
- Y – Yielding or unstable surface
Non-Emergency Moves
Non-emergency moves allow for careful patient handling with maximum attention to spinal immobilization and injury prevention. These moves are preferred when scene safety permits adequate time for proper technique execution. The emphasis is on minimizing patient movement and maintaining anatomical alignment.
Non-Emergency Move Principles:
- Maintain spinal alignment throughout movement
- Use adequate personnel for safe lifting
- Communicate clearly among team members
- Move patient as single unit when possible
- Support all body segments during transfer
Specialized Transfer Techniques
Certain situations require specialized transfer techniques adapted to specific clinical presentations or environmental challenges. These include rapid extrication techniques, confined space rescue methods, and transfers for patients with complex medical devices or injuries.
Equipment Selection Decision Tree
Injury severity, consciousness level, stability
Space constraints, terrain, weather
Standard stretcher
Spine board/vacuum
Rapid extraction
Team Coordination and Communication
Successful patient transfer requires coordinated team effort with clear communication protocols. The team leader directs all movements, ensures proper body mechanics, and monitors patient response throughout the transfer process. Each team member must understand their specific role and responsibilities.
Team Roles During Transfer:
- Team Leader: Overall coordination, airway management
- Assistant #1: Torso control, chest/shoulder support
- Assistant #2: Hip and pelvis stabilization
- Assistant #3: Lower extremity support
- Equipment Manager: Device preparation and positioning
Special Situations and Considerations
Certain clinical and environmental situations require modified approaches to patient transportation. These special circumstances may involve unique injury patterns, challenging environmental conditions, or patients with pre-existing medical conditions that complicate standard transport protocols. Flexibility and clinical judgment are essential for optimal outcomes.
Pediatric Considerations
Pediatric trauma patients present unique challenges due to anatomical and physiological differences from adults. Children have proportionally larger heads, more flexible spine structures, and different injury patterns. Standard immobilization equipment often requires modification or specialized pediatric-sized alternatives.
Pediatric Anatomical Considerations:
- Larger occiput creates cervical flexion on flat surfaces
- Shorter neck requires modified collar sizing
- More pliable rib cage affects chest injury assessment
- Higher surface area to body mass ratio increases heat loss
- Psychological needs requiring family presence when possible
Geriatric Considerations
Elderly patients present increased complexity due to age-related physiological changes, comorbid conditions, and medication effects. Osteoporosis increases fracture risk, while cardiovascular disease may limit compensatory responses to trauma. Cognitive impairment can complicate assessment and cooperation during transport.
Geriatric Risk Factors:
- Anticoagulation therapy increasing bleeding risk
- Osteoporosis and increased fracture susceptibility
- Decreased physiological reserve
- Multiple medications affecting response
- Cognitive impairment complicating assessment
Pregnancy and Trauma
Pregnant trauma patients require consideration of both maternal and fetal well-being. Physiological changes of pregnancy affect injury patterns and physiological responses. Left lateral positioning may be necessary to prevent aortocaval compression, while fetal monitoring may be indicated for viable pregnancies.
PREGNANT Trauma Considerations
- P – Position left lateral to avoid compression
- R – Rapid transport for viable pregnancies
- E – Examine for vaginal bleeding
- G – Gestational age assessment
- N – Notify receiving facility of pregnancy
- A – Assess fetal movement if conscious
- N – Never delay maternal care for fetal concerns
- T – Two patients to consider in decision making
Environmental Challenges
Adverse environmental conditions such as extreme temperatures, confined spaces, or hazardous materials exposure require modified transport approaches. These situations may limit equipment options, require specialized protective gear, or necessitate decontamination procedures before transport.
Environmental Adaptations:
- Cold Weather: Hypothermia prevention, equipment function
- Hot Weather: Heat illness risk, hydration needs
- Confined Spaces: Limited access, equipment modification
- Hazmat Exposure: Decontamination requirements
- Water/Ice Rescue: Specialized extraction techniques
Nursing Roles and Responsibilities
Nurses play pivotal roles throughout the trauma transportation continuum, from initial scene response through hospital handoff. Their responsibilities encompass clinical assessment, patient advocacy, family support, and quality assurance. The nursing perspective emphasizes holistic care, patient comfort, and systematic clinical evaluation during the transport process.
Pre-Hospital Nursing Functions
Flight nurses and critical care transport nurses provide advanced clinical expertise during patient transport. Their scope includes advanced assessment skills, medication administration, invasive monitoring, and complex clinical decision-making. These nurses often manage the most critically ill patients requiring specialized interventions during transport.
Advanced Practice Nursing Interventions:
- Advanced airway management including intubation
- Invasive monitoring and hemodynamic assessment
- Medication administration and titration
- Blood product administration during transport
- Complex wound management and bleeding control
Hospital-Based Nursing Preparation
Emergency department and trauma nurses prepare to receive transported patients by gathering necessary equipment, assembling response teams, and preparing treatment areas. Their responsibilities include communication with transport teams, family notification, and ensuring seamless care transitions upon patient arrival.
Nursing Transport Preparation Sequence
ETA, patient condition, resource needs
MD, RN, RT, support staff notification
Monitors, medications, airway supplies
Notification, support, information sharing
Quality Assurance and Documentation
Nurses participate in quality improvement initiatives by documenting transport-related outcomes, identifying system improvements, and participating in case review processes. Their clinical expertise contributes to protocol development and staff education programs that enhance transport safety and effectiveness.
QUALITY Nursing Assessment
- Q – Quick initial impression and triage
- U – Urgent interventions identified and performed
- A – Assessment systematic and complete
- L – Life-saving measures prioritized
- I – Immobilization appropriate and effective
- T – Transport decisions evidence-based
- Y – Yearlong learning and improvement focus
Patient and Family Advocacy
Nursing advocacy extends beyond clinical interventions to include patient comfort, family support, and ethical considerations during transport. Nurses often serve as primary communicators with families, providing updates, explaining procedures, and addressing concerns throughout the transport process.
Holistic Nursing Considerations:
- Pain management and comfort measures
- Anxiety reduction and emotional support
- Cultural and religious considerations
- Communication adaptations for special needs
- Privacy and dignity maintenance during transport
Transport Modes and Decision Making
The selection of appropriate transport modes represents a critical decision point that impacts patient outcomes, resource utilization, and healthcare costs. Modern emergency medical systems offer multiple transport options, each with specific indications, advantages, and limitations. Evidence-based criteria guide these decisions to optimize patient care while managing system resources effectively.
Ground Ambulance Transport
Ground ambulances remain the primary transport mode for most trauma patients, offering cost-effective care with trained paramedics and emergency medical technicians. Modern ambulances provide mobile intensive care capabilities including advanced life support, medication administration, and continuous monitoring throughout transport.
Ground Transport Advantages:
- Widely available and cost-effective
- Weather-independent operation
- Larger working space for interventions
- Ability to stop for extended procedures
- Direct hospital-to-hospital transfers
Air Medical Transport
Helicopter emergency medical services (HEMS) provide rapid transport and advanced clinical capabilities for critically injured patients. Air transport is particularly valuable for accessing remote locations, overcoming geographical barriers, and providing specialized medical crews for complex patients.
HELICOPTER Utilization Criteria
- H – High-energy mechanism of injury
- E – Extended ground transport time (>30 min)
- L – Limited ground access to scene
- I – Intensive care capabilities needed
- C – Critical injuries requiring trauma center
- O – Optimal weather and safety conditions
- P – Prolonged extrication anticipated
- T – Time-sensitive interventions needed
- E – Emergency physician or nurse required
- R – Remote location with limited resources
Fixed-Wing Aircraft Transport
Fixed-wing aircraft provide long-distance transport capabilities for stable patients requiring specialized care at distant facilities. These aircraft offer pressurized cabins, extended range, and space for complex medical equipment while maintaining higher speeds than ground or helicopter transport.
Fixed-Wing Indications:
- Inter-facility transfers >150 miles
- Organ transplant transport requirements
- Specialized pediatric or cardiac care needs
- International repatriation services
- Mass casualty incident overflow transport
Transport Decision Matrix
Transport mode selection requires systematic evaluation of patient factors, system resources, and environmental conditions. Decision-making tools help standardize this process while allowing for clinical judgment and situational adaptations.
Transport Mode Decision Algorithm
Vital signs, injury severity, stability
Distance, terrain, traffic patterns
Transport units, weather, crew capability
Standard care, local facilities
Critical care, trauma center
Long distance, specialty care
Documentation and Communication
Comprehensive documentation and effective communication form the foundation of quality trauma care throughout the transport process. Accurate record-keeping ensures continuity of care, supports quality improvement initiatives, and provides legal protection for healthcare providers. Modern documentation systems emphasize efficiency while maintaining thoroughness and accuracy.
Essential Documentation Components
Transport documentation must capture all relevant clinical information, interventions performed, patient responses, and communication efforts. The documentation should tell the complete story of patient care from initial contact through receiving facility handoff.
DOCUMENT Everything Rule
- D – Demographics and chief complaint
- O – Objective findings and vital signs
- C – Clinical interventions performed
- U – Understanding of mechanism of injury
- M – Medications administered
- E – Equipment used and monitoring
- N – Neurological status changes
- T – Times for all critical events
SBAR Communication Framework
The SBAR (Situation, Background, Assessment, Recommendation) framework provides structured communication for transport teams. This standardized approach ensures comprehensive information transfer while reducing miscommunication and improving patient safety outcomes.
SBAR Transport Report Structure:
- Situation: Current patient status and immediate concerns
- Background: Mechanism of injury, medical history, timeline
- Assessment: Current vital signs, clinical findings, interventions
- Recommendation: Suggested care priorities and resource needs
Electronic Documentation Systems
Modern transport systems increasingly utilize electronic documentation platforms that integrate with hospital systems, reduce documentation time, and improve data accuracy. These systems often include template-based entries, automatic time stamping, and real-time communication capabilities.
Electronic Documentation Benefits:
- Improved legibility and completeness
- Automatic calculation of scores and intervals
- Real-time data sharing with receiving facilities
- Enhanced quality assurance capabilities
- Reduced documentation time burden
Legal and Regulatory Considerations
Transport documentation must comply with federal regulations, state requirements, and accreditation standards. Healthcare providers must understand their legal obligations while maintaining patient confidentiality and ensuring accurate record-keeping that supports clinical decision-making.
Legal Documentation Requirements:
- Accurate timing of all interventions
- Clear rationale for transport decisions
- Documentation of informed consent when applicable
- Patient condition changes and responses
- Communication attempts with receiving facilities
Complications and Management
Transport-related complications can significantly impact patient outcomes and require immediate recognition and management. These complications may result from the primary injury, develop during transport, or arise from interventions performed during care. Anticipating potential problems and maintaining readiness for rapid response are essential components of safe transport practice.
Airway Complications
Airway complications represent the most immediately life-threatening transport emergencies. These may include airway obstruction, aspiration, equipment failure, or loss of previously established airway access. Recognition and intervention must occur within minutes to prevent catastrophic outcomes.
Airway Emergency Management:
- Immediate recognition of airway compromise signs
- Manual airway maneuvers as first-line intervention
- Suction readily available for secretion management
- Backup airway equipment prepared and accessible
- Consider surgical airway for complete obstruction
Hemodynamic Instability
Cardiovascular complications during transport may result from ongoing blood loss, fluid shifts, medication effects, or position changes. Continuous monitoring and rapid intervention capabilities are essential for managing hemodynamic instability during transport.
SHOCK Management Protocol
- S – Stop obvious bleeding sources
- H – Hemodynamic monitoring continuous
- O – Oxygen delivery optimization
- C – Circulation support with fluids/blood
- K – Keep warm to prevent hypothermia
Equipment-Related Complications
Medical equipment failure during transport can create dangerous situations requiring immediate problem-solving and backup planning. Regular equipment checks, redundant systems, and alternative intervention strategies help minimize equipment-related complications.
Equipment Failure Response Protocol
Alarms, visual inspection, performance check
Patient status, immediate risks
Alternative equipment, manual techniques
Continue vs. divert to nearest facility
Environmental and Transport-Specific Issues
The transport environment creates unique challenges including motion effects, noise interference, limited space, and variable environmental conditions. These factors can complicate patient assessment, intervention delivery, and communication efforts.
Transport Environment Hazards:
- Motion sickness affecting patients and crew
- Noise interference with assessment
- Vibration affecting equipment function
- Limited working space constraining interventions
- Vehicle accidents during emergency response
Prevention Strategies
Proactive prevention measures significantly reduce the likelihood and severity of transport complications. These strategies include systematic equipment checks, crew training programs, standardized protocols, and regular quality improvement initiatives.
Complication Prevention Measures:
- Pre-transport equipment verification procedures
- Crew resource management training
- Standardized clinical protocols and checklists
- Regular simulation-based training exercises
- Continuous quality improvement programs
Quality Improvement and Best Practices
Quality improvement in trauma transportation requires systematic evaluation of processes, outcomes, and system performance. Modern approaches emphasize evidence-based practice, continuous learning, and data-driven decision making to enhance patient safety and optimize resource utilization. Quality programs must address clinical outcomes, patient satisfaction, cost effectiveness, and safety metrics.
Performance Metrics and Indicators
Effective quality improvement programs establish measurable indicators that reflect system performance across multiple domains. These metrics provide objective data for identifying improvement opportunities and tracking progress over time.
METRICS for Transport Quality
- M – Mortality and morbidity outcomes
- E – Equipment reliability and readiness
- T – Time intervals and response efficiency
- R – Resource utilization appropriateness
- I – Incident rates and safety events
- C – Cost effectiveness and budget impact
- S – Satisfaction scores from patients/families
Evidence-Based Protocol Development
Clinical protocols should reflect current evidence and best practices while allowing for appropriate clinical judgment. Regular protocol review and updates ensure that practices remain current with evolving evidence and changing technology capabilities.
Protocol Development Process:
- Literature review and evidence synthesis
- Expert panel consultation and review
- Pilot testing and feasibility assessment
- Staff education and implementation planning
- Outcome monitoring and continuous refinement
Safety Culture and Reporting Systems
A strong safety culture encourages open reporting of safety events, near misses, and improvement suggestions. Non-punitive reporting systems provide valuable data for identifying system vulnerabilities and developing preventive strategies.
Safety Event Analysis Process
Incident reporting, detection systems
Comprehensive investigation, interviews
System factors, contributing causes
System changes, education, monitoring
Education and Competency Programs
Ongoing education ensures that transport team members maintain current knowledge and skills. Competency programs should address clinical skills, equipment use, communication abilities, and crisis management capabilities.
Educational Program Components:
- Initial orientation and skills validation
- Annual competency assessments
- Simulation-based training scenarios
- Continuing education requirements
- Peer review and mentoring programs
Future Directions and Innovation
The future of trauma transportation will likely include technological advances such as telemedicine integration, artificial intelligence-assisted decision making, and enhanced monitoring capabilities. These innovations promise to improve outcomes while managing costs and resource constraints.
Emerging Trends in Transport Medicine
- Telemedicine consultation during transport
- Point-of-care ultrasound and diagnostic capabilities
- Artificial intelligence for triage and resource allocation
- Enhanced monitoring with wearable technology
- Drone-assisted medical supply delivery
- Virtual reality training and assessment tools
Key Takeaways for Nursing Practice
Safety First: Scene safety and provider protection are prerequisites for effective patient care.
Systematic Assessment: Follow established protocols while maintaining clinical flexibility.
Team Communication: Clear, structured communication prevents errors and improves outcomes.
Continuous Learning: Stay current with evidence-based practices and emerging technologies.
Patient Advocacy: Balance technical skills with compassionate, holistic care.
Quality Focus: Participate actively in improvement initiatives and outcome evaluation.
© 2025 Educational Resource for Nursing Students | Transportation of Injured Persons
This document serves as an educational guide and should be supplemented with current clinical guidelines and institutional protocols.