Anesthesiology, Perioperative and Pain Medicine

Adult Critical Care Transport Program

In 1979, the Anesthesia Intensive Care Program recognized the potential to increase the number of ICU patients at Stanford Hospital and the need to offer its services to outlying facilities lacking the personnel, equipment and expertise of a tertiary care hospital. Following the example provided by the Pediatric/Neonatal transport program under the leadership of Alvin Hackel, Professor of Anesthesia at Stanford, Mike Rosenthal, the Director of Stanford’s Adult Intensive Care Program, along with Jan Ehrenwerth from the Department of Anesthesia and an assistant to Dr. Hackel, established an adult critical care transport program. The chief administrator of the hospital, Peter Levin, understood the value of such a program both to Stanford and the community and with a grant from the hospital the necessary monitoring and patient care equipment was purchased. The ICU nursing service and the respiratory therapy department cooperated fully as did the existing neonatal/pediatric dispatch center and the program was established later that year. The initial personnel involved consisted of ICU nurses and respiratory therapists as well as the ICU service attendings. The first transport in 1979 was done under the direction of Tom Feeley, an anesthesia ICU attending, who transported a young women with a pulmonary embolus to Stanford by fixed wing aircraft and the following week Mike Rosenthal and Jan Ehrenwerth transported an elderly man in cardiogenic shock following aortic valve replacement surgery to Stanford also by fixed wing aircraft (see picture).

For the first 2 years all adult transports arranged through this service were supervised by one of the ICU attending physicians (Drs. Feeley, Mihm, Raffin, Rosenthal and Sladen) directly present and involved with every transport. Transports were conducted by either ground ambulance or the combination of ambulance and fixed wing aircraft operated by Air Ambulance out of the San Carlos Airport. Beginning around 1981 with physicians still present on all transports along with ICU nurses and respiratory therapists, ICU fellows and subsequently senior anesthesia residents began providing the physician support with constant communication with an ICU attending at Stanford. In the early years of this program between 50 and 75 patients were transported annually to Stanford. This program also was used to transport patients often requiring ventilatory support to facilities closer to their home as well as bringing critically ill patients to Stanford from far distances including Europe. The program not only served to bring patients to Stanford to be managed by the intensive care service but other services as well including neurosurgery and cardiac surgery and was also used for providing nursing and physician support for organ harvest for Stanford’s transplantation programs.

The Adult Critical Care Transport Program with on-site physician supervision provided care for patients in outlying hospitals assuming full responsibility following consultation and agreement by the referring physicians remaining in the referring hospital for prolonged periods of time to provide necessary stabilization in order to transport in the safest manner possible. This would involve the initiation of invasive monitoring and the establishment of complex therapies to attain both hemodynamic and respiratory stability. During its existence no patient was ever lost during a transport of some of the most complex pathophysiologic processes.

In 1984, Stanford Hospital determined that the existing program should be expanded to include helicopter rescue of on-scene accident victims. Progressively over the next 2 decades physician presence on the majority of transports was eliminated with the expectation that transports involving critically ill patients from referring hospitals would have ICU attending involvement to determine the need for physician presence, a policy that exists to the present time. With the establishment in 1984, of the Life Flight Program, the former Adult Critical Care Transport Program was gradually phased out of existence. The training of Life Flight Nurses resulted in the replacement of the previous intensive care nurse on the transports. The Adult Critical Care Transport Program set the stage for the current highly successful Life flight Program at Stanford Medical Center by providing the most expert and safest means for needed assistance to referring facilities and physicians with the assurance that their patients would receive the best critical care management available.

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