The features of the transport environment that may distinguish this environment from the inpatient setting and the effects of these features on patients and caretakers include the following:

1. Excessive noise. The acute effects of excessive noise on older pediatric and adult patients are probably minimal. By contrast, persistent sound in excess of 80 dB appears to dramatically increase the frequency of arterial oxygen desaturation in premature infants. In addition, excessive noise makes it virtually impossible to use the sense of hearing to evaluate patients during transport.

2. Vibration. The effects of vibration on patients are uncertain but are probably not of great significance. However, vibration may limit the reliability of transport equipment. Monitor artifact must be recognized, and alternative techniques for monitoring should be employed as needed.

3. Inadequate lighting. Inadequate lighting is rarely a problem during the transport of adult patients because EMS vehicles generally have lighting designed for adult patients on stretchers. However, task lighting for illuminating small areas and small patients is usually not available.

4. Variable ambient temperature. Although the range of ambient temperature encountered during transport rarely influences the body temperature of adult patients, environmental conditions can have a dramatic influence on the body temperature of neonates and small children.

5. Changes in barometric pressure. Changes in barometric pressure during ascent in nonpressurized aircraft cause expansion of gases in closed spaces (e.g., with endotracheal tube cuffs or pulmonary interstitial emphysema) and a fall in the partial pressure of oxygen. These changes are rarely of sufficient magnitude to influence physiologic characteristics unless the change in altitude is greater than approximately 1500 m.

6. Confined space. The confined space in transport vehicles is an obvious handicap because it limits the number of caretakers and the amount of support equipment.

7. Limited support services and personnel. Similarly, the extent and precision of care is limited during transport by the lack of support services (e.g., radiographic and laboratory services) and specialty personnel.

8. Equipment failure. Equipment failure during transport is common and is particularly problematic because replacement equipment is less likely to be available in the vehicle than in an inpatient setting. The most common problem is the unexpected exhaustion of an oxygen tank.

9. Motion-induced illness. Many medical personnel develop motion-induced illnesses during transport. Symptoms are often categorized into one of two syndromes: the sopite syndrome, which is characterized by drowsiness and inability to concentrate, and the nausea syndrome. Either syndrome may impair the ability of personnel to provide skilled care.

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