Clinical care during transport: DipIMC practice questions

Answer: B

Tell the crew to stop the vehicle in a safe place, then assess and treat

ICS/FICM transfer guidance says that if an unforeseen emergency needs urgent intervention, it should not be attempted in a moving ambulance: the crew should be advised and the vehicle stopped appropriately in a safe place before treatment is given. Unbelting at speed puts the clinician and everyone in the vehicle at risk. Turning the oxygen up and pressing on treats the number rather than the cause, and the likely causes (a displaced or obstructed tube, a disconnection, a pneumothorax) worsen while you travel. An unassessed diversion abandons the plan on no information, and telephoning first delays assessment of a hypoxic patient. The CCSTT workbook adds that, whatever transfer ventilator is used, a self-inflating bag must be available at all times in case of oxygen or ventilator failure. A documented record of observations and events must be maintained, so the episode is recorded once the patient is stable.

Answer: A

A formal verbal and written handover that includes treatment limitation decisions and resuscitation status

ICS/FICM guidance says that on arrival there should be a formal handover between the transport team and the receiving medical and nursing staff, who then assume responsibility for the patient and their relatives. It should include a verbal and written account of the history, vital signs, therapy, significant clinical events, X-rays, scans and other investigations, together with details of advance directives, treatment limitation decisions, resuscitation status, and the information given to the patient and relatives. Those last items are the ones most easily lost between teams. A verbal-only handover with notes left for later, or a written-only summary, falls short of the verbal and written standard; a telephone call before arrival does not replace the bedside handover; and a journey-only handover leaves out the history the guidance lists. The CCSTT workbook teaches a concise, structured handover using SBAR.