Adverse clinical events during intrahospital transport by a specialized team: a preliminary report.

BACKGROUND: Caring for patients during intrahospital transport is a high-risk activity. Few data exist on the use of specialized transport teams similar to the teams used for out-of-hospital transport. OBJECTIVE: To describe the experience with a dedicated, intra-hospital transport program, to report the rate of clinically significant adverse events, and to examine types of adverse events, interventions provided, and outcomes. METHODS: Patient transports within an academic quaternary-care hospital from November 2007 through April 2008 were retrospectively reviewed. Adverse events were defined as extubation, code team activation, death, sustained arrhythmia, hypoxia exceeding 5 minutes, hypotension exceeding 20% of baseline systolic or diastolic blood pressure and requiring intervention, use of physical restraints, or acute change in mental status. RESULTS: A total of 3383 charts were reviewed (91.8% of all completed transports).The overall rate of adverse events was 1.7% (59 events). Most events were related to hypoxia (25/59) and blood pressure changes (25/59). One extubation and one code team activation occurred. Most interventions involved adjustments to oxygen therapy (22/59) and vasopressor management (18/59). Only 12 (20.3%) of the transports with adverse events were aborted, more often during magnetic resonance imaging (χ(2) = 6.86, df = 1, P = .01) and in older patients (mean [SD], 70.8 [14.2] vs 58.7 [14.9] years; P = .02). CONCLUSIONS: The rate of clinically significant adverse events during patient transport by a specialized team is relatively low. Further studies are needed to compare effectiveness and mortality benefits between intrahospital transport teams and traditional transport teams.

Hospital-based event medical support for the Baltimore Marathon, 2002-2005.

OBJECTIVES: We present a four-year, cross-sectional epidemiologic description of injuries and illnesses among Baltimore Marathon participants and the evaluation, treatment, and disposition of those conditions by an on-site event medical team led by physicians and staff from an urban, academic emergency department. METHODS: We analyzed data from injuries encountered during the marathon. Subjects presenting to a medical aid station along the course route or at the finish line were defined as "injured or ill" and were prospectively divided into two groups: 1) a brief-encounter group and 2) an extended-encounter group. Data collected included gender, presenting complaint(s), assessment, treatment(s), and disposition. RESULTS: Three percent (N=1,144) of approximately 33,700 total participants over four years presented to medical aid stations during the Baltimore Marathon between 2002 and 2005. Most participants (66%) did not require a full clinical evaluation. Common complaints encountered were dehydration (32%), musculoskeletal injuries (25%), and cutaneous wounds (20%). Transport to the hospital was required for 4% of all injured participants, and 61% returned to the race. CONCLUSIONS: Most injuries/illnesses encountered at the Baltimore Marathon in 2002-2005 were minor, although some were serious enough to require transport to a hospital. The year with the highest average race-day temperature had the highest observed injury rates and the highest number of hospital transports. These results help to improve understanding of the types, severity, and distribution of injuries commonly sustained by marathon participants and may guide decisions regarding the appropriate distribution of emergency medical resources at such events.