DEFINITION AND CLASSIFICATION
DEFINITION.
We characterize TS (Sanitary Transport), as indicated by
Royal Decree 1.211/1.990 in its article
133, for example, that improved the situation the dislodging
of wiped out individuals,
for other wellbeing reasons, in vehicles exceptionally
impact.
Arrangement AND TYPES OF SANITARY TRANSPORT
We arranged TS as per diverse criteria:
an) According to the reason for the vehicle:
- Primary or extrahospital transport: The one that is done
from the place
where the crisis jumps out at the clinic. This sort of
transport is the
principal goal of this subject.
- Secondary or interhospital transport: The one did from a
clinic to
other.
- Tertiary or intrahospital transport: Within the healing
facility itself.
(b) Depending on the methods for transport utilized:
- Ground transportation: Ambulances.
- Air transport: Helicopters or restorative air ship.
- Maritime: Speedboats, healing center pontoon.
In light of the separation to be voyage, either methods for
transport:
- For separations under 150 km, earthbound or
helicopters.
- Between 150 and 300 km the ideal methods for transport is
the wellbeing helicopter.
- Distance in the vicinity of 300 and 1,000 km. Make the
utilization of the planes fitting.
- The bosses to 1000 km advantage from the exchange by
consistent line
adjusted.
- For certain exceptional conditions the ship or railroad is
cleared out.
c) According to the key circumstance of the patient:
- Emergency transport: must be done instantly. Has need
outright
- Urgent transport: it can take minutes or hours. These are
patients
with conceivable key hazard.
- Delayable transport: transport can be modified. Does not
require
prompt help.
d) According to the level of medicalization of the vehicle
framework:
- Non-restorative ambulances: no enrichment for human
services. Utilized
to transport patients on a stretcher.
- Ambulances: arranged for human services on the way:
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o Non-medicalized. Without discretionary staff. Can offer
help
imperative fundamental.
o Medicated. With discretionary staff. Give imperative help
progressed.
- Sanitary helicopter.
- Sanitary air ship.
PHYSIOPATHOLOGY OF SANITARY TRANSPORT.
The main thought to be considered amid TS, regardless of
whether essential or
modified (optional and tertiary), is the solid mental effect
that it
the cognizant patient. This effect is limited by educating
the patient, if conceivable,
relatives or sidekicks about the restorative exercises that
will be done
the explanation behind the exchange, the challenges of the
exchange, the estimated time
landing and place of goal.
Having called attention to out, we should consider that
preparing a patient,
despite the methods for transport utilized, involves the
activity of an arrangement
of outer components about himself, about the staff that he
watches over and even
on the material utilized. These components prompt
physiological changes that
can exasperate the patient's condition, so it is critical to
know them. The
physiological changes are created by, among others, the
impact of gravity, commotion,
vibrations, temperature, turbulence and stature.
GRAVITY. Speeding up DECELERATION.
The speed changes amid TS, the two builds (increasing speed)
and
(deceleration) of the same, cause physiological changes in
the
living being. Increasing speeds decelerations cause
relocation of fluids and
masses inside the life form. These developments are caught
by recipients
inciting reactions that can go from changes in weight
intracranial weight, diminish in pulse and increment in
heart rate, up to
discomfort and vagal pictures.
In the earthly TS, longitudinal increasing speed is the most
critical; being of
transverse or anteroposterior increasing speeds in TS in
helicopter. For all the above we will consider the
accompanying:
- Avoid, beyond what many would consider possible, sudden
increasing speeds and decelerations by
normal and judicious driving.
- The position of the patient will differ as per the sort of
TS:
the earthly TS. Persistent in prostrate position with head
in the feeling of
the bearing of travel.
the flying TS. In transverse or the other way
of the March.
- Correct port of the stretcher to the vehicle and the
patient on the stretcher, utilizing
indeed, even the vacuum sleeping pad for its ideal
immobilization.
- Use of safety belts by going with faculty.
- Correct settling and assurance of the material and
utilization of imbuement pumps
for the organization of vasoactive medications.
Clamor.
Contingent upon the kind of TS utilized, the clamor source
and its force level will differ. So
in arrive transport the commotion is for the most part caused
by the sirens of the
ambulances; in spite of the fact that record should likewise
be taken of activity
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streets, put away electromedical material and the vehicle's
own clamor. At
air transport, particularly in helicopters, the clamor level
is high.
up to 110 decibels.
From the above we can finish up:
o Use the sirens of the ambulances, just on the off chance
that it is fundamental,
o Noise may keep certain exercises, for example,
auscultation
of the patient, the taking of circulatory strain, the
knowing about sound alerts, and so on.
o Taking into account that clamor levels of 70 db. cause
changes in the
rest in grown-ups and changes in heart rate and
vasoconstriction
fringe neuropathy in the neonate, and in addition causing
tension and
vegetative; acoustic assurance measures ought to be taken
for the
persistent, particularly in ethereal TS.
VIBRATIONS.
Vibrations can be decreased in the accompanying ways:
or, on the other hand TS vehicles in culminate mechanical
condition.
o Suspension satisfactory and in idealize condition.
Utilization of gliding stretchers.
o Immobilization of the patient with a vacuum sleeping
cushion.
TEMPERATURE.
Hypothermia and hyperthermia cause physiological changes in
the body.
Hypothermia, to which is especially delicate the injury
tolerant presented to
air, can cause from chills to vascular crumple. The
hyperthermia causes fringe vasodilation and metabolic
modifications due to
of sweating. This can be stayed away from:
o Air molding framework in the vehicle.
o Use of warm covers.
o Avoid, beyond what many would consider possible, the
introduction of TS vehicles to cool or warmth.
TURBULENCES.
They are caused by the air going through the airborne TS
vehicle. It causes jerks
which can be a wellspring of observing mistakes and
breakdowns.
This is maintained a strategic distance from with a decent
settling framework that keeps individuals and
material.
Stature.
The reduction of the incomplete weight of oxygen and decline
of the climatic weight
decides the central impacts that the stature causes in which
it flies.
The physiological impacts of hypoxemia happen from 1000 m.
Among them
features the expansion in heart yield and reflex
hyperventilation, respiratory alkalosis,
tetany and obviousness. Consequently, patients with
respiratory or heart deficiency,
hypovolemia, weakness, stun, and so on., can be
destabilized. As a central measure
we will change the Fi O2 by checking the incomplete weight
of O2 by beat oximetry.
Weight changes going with elevation changes may influence
patients and a substantial number of restorative gadgets.
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VALUATION AND STABILIZATION PRIOR TO TRANSFER
General RATING
Obviously, the basic patient might be for an assortment of
reasons, let us consider
a polytrauma, an AMI, intense mid-region and a long
etcetera, so that in a
the first occasion when we will be occupied with knowing the
general state of the patient, the
furthermore, bolster needs and checking needs that we
need to play out the exchange. For this we will require a
fast assessment
of the crucial capacities, for which we will take after the
accompanying strides:
A. Aviation route with or without cervical spine control, as
proper.
B. Control of ventilation and breath
C. Control of hemorrhages and circulatory help.
D. Neurological examination
E. Presentation of the patient with anticipation of
hypothermia if essential.
Demand the need to take after the means successively without
avoiding any of
they, until the point when we finish up the instantly past
one.
Nitty gritty ASSESSMENT
This stage will intend to efficiently and
patient to have the capacity to identify any additional
issue, either present or
which may entangle the underlying adjustment of the patient.
We will endeavor to know, beyond what many would consider
possible, the patient's therapeutic history,
attempting to assemble all conceivable data from relatives
and/or companions exhibit, also
for example, late medicines and analysis.
At this stage we will record in our medicinal records every
one of those information, values
expository and parameters got amid our intercession with the
patient.
We will audit all help measures started with the patient,
control
circulatory, respiratory control, catheters, pathways, kind
of liquids, medicine, and so forth.
The evaluation will be finished with the neurological status
examination and the
regardless of whether you require sedation.
Readiness
Ampleness of the patient before beginning the exchange,
comprehended as a right
treatment of the patient into the inside of the emergency
vehicle, putting it in the
most appropriate position and looking for most extreme
immobilization taking awesome care,
every one of those ways, tests and other material that the
patient conveys, staying away from that
can endure any extubation and/or coincidental evacuation of
any of the adornments,
notwithstanding putting and interfacing all apparatuses to
their energy sources and
understanding exchange from our care unit to the middle area
counting an itemized and finish medicinal history
urgencies, and in addition the patient's close to home
history, episodes amid the exchange
also, drug and other instrumental help gave amid the
exchange
