From the Guidelines
Conditions that necessitate urgent transport to a hospital include severe chest pain suggesting heart attack, stroke symptoms, severe breathing difficulties, uncontrolled bleeding, severe burns, major trauma, loss of consciousness, seizures lasting more than five minutes, severe allergic reactions, suspected poisoning or overdose, and severe abdominal pain. These conditions require immediate medical attention because they can rapidly deteriorate and lead to permanent damage or death without prompt treatment 1. While waiting for emergency services, basic first aid should be provided:
- for heart attacks, have the person rest and take aspirin if not allergic;
- for strokes, note the time symptoms began;
- for bleeding, apply direct pressure;
- for anaphylaxis, use an epinephrine auto-injector if available. Do not give food or drink to someone requiring urgent transport as this may complicate emergency procedures. Always call emergency services immediately rather than attempting to transport the person yourself, as ambulances provide life-saving care during transit and ensure faster access to hospital treatment upon arrival 1. In the case of stroke patients, they should be transported to designated stroke centers, which can provide timely and appropriate treatment, including thrombolytic therapy 1. If transportation to a stroke center is not possible within the appropriate time, patients should be taken to the closest hospital equipped to treat stroke patients quickly, with computed tomography or magnetic resonance imaging and experienced healthcare providers 1. For critically ill patients, such as those with cardiac arrest, repetitive episodes of ventricular tachyarrhythmias, severe bradycardia, or in shock, transport to a hospital with cardiac catheterization and cardiac surgery facilities is recommended, if this does not require excessive transport time 1.
From the FDA Drug Label
CONTRAINDICATIONS Known hypersensitivity or allergy to morphine (4) Bronchial asthma or upper airway obstruction (4) Respiratory depression in the absence of resuscitative equipment (4) Paralytic ilieus (4) The conditions that need urgent transport to hospital are not explicitly stated in the provided drug label. However, based on the contraindications, the following conditions may require urgent medical attention:
- Respiratory depression
- Bronchial asthma or upper airway obstruction
- Known hypersensitivity or allergy to morphine
- Paralytic ileus 2
From the Research
Conditions Requiring Urgent Transport to Hospital
The following conditions require urgent transport to hospital:
- Acute myocardial infarction (AMI) with severe in-hospital complications such as cardiopulmonary arrest, shock, stroke, atrioventricular block, and respiratory failure 3
- Cardiac trauma, including blunt cardiac trauma and penetrating chest injuries, which can lead to aortic injuries 4
- Acute ischemic stroke (AIS) associated with myocardial infarction, which requires time-sensitive treatments and expert consultation 5
- Concomitant cerebral infarction and acute myocardial infarction, which is associated with significant increase in mortality, length of stay, and cost compared to admissions with either condition alone 6
Key Considerations
When transporting patients with these conditions to hospital, it is essential to:
- Provide timely diagnosis and early management to improve mortality 4
- Employ time-sensitive treatments, such as reperfusion therapy for AMI and alteplase for AIS 5
- Recognize the increased risk of stroke for up to 3 months following AMI and the importance of aggressive treatment of AMI to decrease this risk 5
- Consider the potential for troponin elevations in the setting of AIS and its implications for short- and long-term mortality 5