Pediatric Transport

Introduction

Critically ill children have a better clinical outcome when treated in tertiary pediatric intensive care units
Centralization of pediatric intensive care units has increased the need for interhospital pediatric transports
Specialized pediatric retrieval teams have been developed in many countries to undertake the stabilization and safe transfer of critically ill children

Composition of Pediatric Transport Teams

Recommend at least two patient care providers per transport, with one being a nurse
Other team members may be: respiratory therapists, physicians, residents, paramedics
Aim to match the skills of the team members to the needs of the patient
Incidence of complications is decreased with dedicated, specialized transport teams

Adverse Events During Transport

Very common (occur up to 50-75% of the time)
Incidence of adverse events proportional to severity of illness prior to transport
Type of adverse events:
- Alteration in vital signs: hypothermia/hyperthermia, hypertension/hypotension, bradycardia/tachycardia
- Equipment related: accidental extubation, loss of oxygen supply, malfunction of ventilator, loss of intravenous catheter infusing vasoactive drugs
- Other: drug error, respiratory arrest, cardiac arrest, death
Minimize adverse events:
- Provide adequate resuscitation prior to transfer
- Provide appropriate monitoring during transfer
- Anticipate potential problems during transfer
- Team composition and equipment should reflect pretransport severity of illness and the anticipated duration of transport

Preparing for Transport: Prior to Leaving Base Hospital

Equipment

Table 2.1 Equipment Required to Transport a Critically Ill Child

Monitors	Heart rate/rhythm Blood pressure Pulse oximetry Temperature Extra batteries
Infusion pumps	Multiple infusions Extra batteries
Resuscitation equipment	Airway equipment Central lines Chest tubes Intravenous and intraosseous needles
Drugs and fluids	Resuscitation drugs Infusion drugs Sedative/paralytic drugs Antibiotics Fluids/blood if necessary
Portable oxygen supply	Check prior to leaving
Ventilator	Appropriate circuit (infant vs child)
Document folder	Patient chart Transport record Information for parents Telephone numbers
Protective clothing	Warm clothes Change of clothes (for long transports) Appropriate footwear
Portable telephone	Extra batteries