Transport of a Prone Position Acute Respiratory Distress Syndrome Patient

We report the case of a non-physician based critical care transport team (registered nurse and paramedic) that successfully initiated prone positioning of a severe acute respiratory distress patient prior to transport to an extracorporeal membrane oxygenation capable teaching hospital. With the increasing use of advanced treatments such as extracorporeal membrane oxygenation, prone positioning, and continuous renal replacement therapy for severe acute respiratory distress syndrome (ARDS), the necessity to transport these patients to specialized hospitals will correspondingly increase. Emergency Health Services Life Flight, the primary critical care transport program in Eastern Canada, developed a prone position protocol to meet this clinical need. Since the implementation of the protocol, we have successfully initiated prone positioning of 2 patients with ARDS before transport to an extracorporeal membrane oxygenation– and continuous renal replacement therapy–capable teaching hospital. This represents the first report of a nonphysician (registered nurse and paramedic) critical care team initiating prone positioning before transport. Consent for publication was only obtained in the second case, which we present here.