The Myth of Too Sick to Fly

With the increasing regionalization of specialized care centers, more acutely ill patients will require transport for highly specialized trauma centers, stroke centers, and ECMO centers. When caring for an unstable patient who needs to travel for tertiary care, a clinician is faced with a difficult decision – keeping a patient at a smaller, under-resourced center, or sending the patient in a vehicle, knowing they may deteriorate, even die, en route. The fear of deterioration and adverse events has lead many clinicians to say that some patients are too sick to transport, even when they would benefit from tertiary care services.
While the risks of deterioration and adverse events are real and supported by data, these risks may be inflated in the mind of clnicians. This is due in part to basic human psychology, or a fear of causing harm. It may also be due to a fear of legal ramifications. However, data indicate that the risk of death in transit is low, and the potential benefit of transport to specialized care is high. Each case must be examined on its own merits, but when considered in context of the best available data, there are likely few patients who are too sick to transport. A better model is to question – will the potential benefits of transport outweigh the risks in this scenario?