I work for an ambulance service that contracts with a large, university based tertiary care center that does heart transplants and discharges a lot of VADs to the community. When these patients present to the local hospitals with any complaint at all, they are transferred back to our cardiac unit. Depending on the acuity of the patient, it may be just me (a paramedic) and my partner, or any combination of RN, RT, perfusionist and physician with us. (We also go pick up the patients that decompensate acutely and need a VAD/transplant eval. Those are usually the ones that are ridiculously sick.)
So, I frequently transport fairly stable VAD patients back by myself. (We have 2 cities that are 70 miles away that have a lot of our patients; but the trip can be as much as 300 miles one way.) Some patients have pulses and measurable BPs, some don't. The big thing they hammer into us when training and educating is to go by perfusion, including mental status, skin color and urine output. I always check the battery power and the flow rate. We also need to make sure they are adequately anti-coagulated.
On a recent patient, I walked in to his ED room (at a hospital 70 miles away) and looked at the monitor, seeing that he was in V fib. He was awake, sitting up, and talking. I asked if they normally do anything about that, and he said no, it'll stop on it's own. At our own ED, cardiology is normally very good about getting them out of the ED quickly.
The big thing is that you can't rely on vital sign numbers. They require hands on assessment.
