CTRN common mistakes
CTRN · Understand the traps and how to avoid them.
Records one complete vital-sign set at the referring facility and then does not repeat vital signs until arrival at the receiving facility, relying on monitor alarms as the reassessment.
Packaging, handoff, and movement consume the transport window; the monitor is treated as a substitute for a hands-on check rather than an adjunct to it.
What to do instead
Set mandatory reassessment points in advance (after any patient movement, after every titration or ventilator change, and at fixed intervals such as every 15 minutes when stable and every 5 minutes when unstable), and document the full set each time.
Confirms endotracheal tube position by auscultation and chest rise alone, without continuous waveform capnography during movement and handoff.
Ambient noise, vibration, and patient repositioning make auscultation unreliable, and a tube can migrate during transfer between stretcher and aircraft or ambulance cot.
What to do instead
Apply waveform capnography from intubation through handoff, document the EtCO2 value and waveform presence, and recheck tube depth and breath sounds after every move and before transfer of care.
Leaves ventilator settings and gas-filled devices unchanged when cabin altitude changes, without reassessing peak pressures or a known pneumothorax.
Candidates focus on the patient's physiology at ground level and do not carry the gas-expansion concept into the transport phase.
What to do instead
Build a preflight altitude plan, reassess peak inspiratory pressures and breath sounds after altitude change, adjust FiO2/PEEP as needed, and have decompression equipment immediately available if a pneumothorax is present.
Titrates a vasopressor to a systolic blood-pressure target while never documenting a perfusion endpoint such as mentation, capillary refill, urine output, or lactate.
The blood pressure is numeric and continuously displayed, while perfusion requires synthesis across multiple findings, so it is easier to chase the number.
What to do instead
Pair every pressure target with a named perfusion endpoint before transport begins, and reassess and document that endpoint after each rate change.
Infuses a vasopressor through a distal peripheral IV in the same extremity as the automatic blood pressure cuff.
Existing lines are convenient and time pressure discourages starting a new one, and the occlusion risk from cuff inflation is not considered.
What to do instead
Use a dedicated proximal large-bore or central line, label the line clearly, check the site every 15 minutes, and stop the infusion immediately at any sign of extravasation.
Accepts the referring diagnosis and skips a repeat head-to-toe secondary survey, so an occult injury is missed behind a distracting mechanism or obvious fracture.
Anchoring on the outside diagnosis and the visible injury short-circuits the structured reassessment habit.
What to do instead
Perform and document a structured secondary survey at the first safe opportunity, including a log roll and abdominal reassessment, and repeat it when the patient's condition or mentation changes.
Administers room-temperature crystalloid and leaves the patient uncovered in a cold aircraft or ambulance.
Attention is consumed by the primary injury and the resuscitation bolus, and heat loss during transport is not treated as a priority.
What to do instead
Use warmed fluids and active warming measures, monitor temperature, and cover the patient before movement and again after boarding.
Performs a single neurologic examination (GCS and pupils) before departure and never repeats it after transport movement or an altitude change.
Neurologic deterioration is quiet and easily masked by the logistics of the move, so a normal first exam creates false reassurance.
What to do instead
Build serial, time-stamped GCS and pupil checks into the transport plan and report any change, however small, to the receiving team.
Boards the patient without completing a pre-transport equipment and safety checklist and without calculating oxygen supply duration.
Urgency and the desire to depart quickly push the checklist out of the sequence, and oxygen consumption is estimated rather than calculated.
What to do instead
Complete a checklist covering stretcher locks, securing of all equipment, battery status, and suction before boarding, and calculate oxygen duration from cylinder pressure, flow rate, and a planned reserve.
Gives an unstructured verbal handoff and documents interventions without times or without recording the accepting provider and the patient's condition at transfer of care.
End-of-transport fatigue and the press of the next assignment compress the report and the documentation into a summary of events rather than a defensible record.
What to do instead
Use a structured handoff format, time-stamp every intervention and medication, and document the accepting provider, the condition at transfer, and all lines and devices in place.