Transporting or transferring a patient before or after management of acute behavioural disturbance

Transporting or transferring a patient with acute behavioural disturbance is complex and involves multiple risks, including risk to the patient, risk to healthcare staff, and risk associated with the transfer or transport itself. Consider whether the benefit of transporting or transferring the patient outweighs the potential harms (eg transferring a patient with dementia from a familiar care environment to an acute care facility may escalate their distress). Ensure the safety of both the patient and healthcare staff (see Reducing the risk of harm). Summon adequate support early if necessary (eg ambulance, security staff, police).

For a patient who retains decision-making capacity, transport cannot proceed without their consent. If the patient lacks capacity to consent, compliance with relevant legislation is imperative (see Principles of care for a patient with acute behavioural disturbance). Ensure a record of the patient’s observations, drug administration and physical restraint, and required legal documentation, accompany the patient in transport.

Before initiating transport or transfer, ensure that any precipitating or predisposing factors that could be contributing to the patient’s acute behavioural disturbance are addressed (eg hunger, thirst, hypoglycaemia, pain, urinary retention, sepsis or trauma). Arrange appropriate transport (eg police vehicle, ambulance), considering the duration of the trip and potential delays. Also arrange supervision or a medical escort, informed by the patient’s clinical requirements (eg potential requirement for further sedation). If the patient has been administered sedation, a clinician who can manage airway compromise and respiratory depression en route should escort the patient. Resuscitation equipment and continuous monitoring of vital signs must be available.

Note: Clinicians involved in the transport and care of sedated patients must be trained and practised in the required monitoring and resuscitation.

If an adult patient has been mechanically restrained, reconsider the need for ongoing restraint; if it is essential, provide a suitable means of safe restraint en route. Restraint must be proportionate to the risk of harm, and only be employed for the minimum duration that ensures the safety of the patient and others; see Mechanical restraint.

If a long journey is expected, provide instructions for repeated sedative drug administration, if required. If a drug is required during transport, use a dose that maintains a safe level of sedation for the patient and healthcare staff.

In some cases, it may be necessary to enlist a specialist medical retrieval team to anaesthetise, intubate, and ventilate the patient for safe transport.