Should We? (When is a patient too unstable to transfer?)

How unstable of a patient should an EMS crew take on an interfacility transport? What criteria should we be looking at to determine if a patient is appropriate for a transfer? How much risk is too much risk?

My phone is ringing. I have no idea what time it is other than the middle of the night. My wife looks at me, shaking her head and mouths “you’re not…are you?” I mouth back, “maybe,” and give her a shrug. We both know it’s work calling, asking me to come in and we both know that I am going to say yes. I’m half-awake at best during the phone conversation, getting bits and pieces of the story. There is something about a really sick patient that OD’ed a few hours ago and is on a vent and flights are grounded. I tell them I will be there soon.

An hour later I am in the ED regretting answering my phone and asking myself why I say yes to these kinds of things.

The patient is a metabolic nightmare having arrested once for EMS on the way to the ED and three more times over the past two hours in the ED. They’re intubated and on a ventilator with both epinephrine and levophed infusing plus a bicarb infusion. A quick glance at the monitor shows that the blood pressure is simply not enough, not even close to a decent MAP. The pulse ox cannot get a reading. No one really knows much about the patient other th