Patient Assessment and Monitoring in Transport
Build the picture before the wheels move
Transport assessment begins with a deliberate, documented baseline: a full set of vital signs, level of consciousness or GCS, pupils, skin and perfusion, pain score, glucose when indicated, and a monitored rhythm strip - all obtained before departure. The transport environment degrades monitoring. Engine noise and vibration corrupt noninvasive blood pressure and ECG, motion creates artifact, low light hides color change, and cabin space limits reassessment. Trends beat single values: a systolic that fell from 130 to 100 while the heart rate climbed matters more than a number that is technically "normal."
What the exam tests
- Prioritizing ABCs over the monitor; treating the patient, not the tracing.
- Recognizing pseudo-arrhythmias from motion and loose leads, and confirming with a pulse check, plethysmograph, and a second lead.
- Reassessment intervals: after any intervention, after any move, and at fixed intervals en route (commonly every 15 minutes when stable, every 5 minutes when unstable).
- Blunted compensation: beta-blockade, pacemakers, spinal cord injury, and advanced age mask tachycardia.
Trap: a question describes a normal blood pressure with a lactate of 4 and asks whether the patient is stable. The answer is compensated shock with a need to escalate and reassess, not reassurance.
Worked example: before lift-off you record 118/70, HR 88, SpO2 96%. Ten minutes into flight: 92/60, HR 104, SpO2 94%, patient "a little sleepy." Rule of thumb: any change in mental status plus a narrowing pulse pressure in a transport patient is early shock until proven otherwise - pause, reassess airway, bleeding, and volume, and document the trend rather than the isolated readings.