Moving a patient who depends on a mechanical ventilator, between hospitals or inside one, is a high-risk task because the airway, oxygen supply or equipment can fail on the way. Careful preparation, continuous monitoring and a clear plan for problems keep the patient safe.
Key symptoms
- Agitation or fighting the ventilator
- Falling oxygen saturation or cyanosis
- Rising heart rate or swings in blood pressure
- High pressure or low volume alarms
- Uneven or reduced chest rise
What you find on exam
- Tube position: depth at the teeth, breath sounds on both sides, equal chest rise
- Waveform capnography present with every breath
- Vital signs, oxygen saturation and sedation level
- Tube, lines, drains and IV pumps secured before moving
- Ventilator settings: mode, tidal volume, rate, PEEP and FiO2
Tests
- Waveform capnography (EtCO2), continuous during transport
- Recent blood gas and chest X-ray from the sending team
- Oxygen supply calculation: enough for the trip plus a reserve
- Handoff report with diagnosis, settings, drugs and code status
Treatment basics
- Match transport ventilator settings to the current ones and check the patient tolerates them
- Keep a bag-valve mask, suction and airway equipment within reach
- Continue sedation and pain control; protect the head and tube during every move
- If the patient worsens, think DOPE: Displacement, Obstruction, Pneumothorax, Equipment
- When in doubt, disconnect and bag-ventilate with 100 percent oxygen
Red flags
- Loss of the EtCO2 waveform (possible tube displacement)
- Sudden drop in saturation with high airway pressures
- Low blood pressure with absent breath sounds on one side (tension pneumothorax)
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Related guides
Sources: NASEMSO National Model EMS Clinical Guidelines; National EMS Education Standards (2021); NREMT psychomotor skill sheets (EMT and Paramedic). Written by Making Synapses. Making Synapses is not affiliated with these organizations.