Regionalized intensive care for neonatology and pediatric care1 focuses expensive, high-technology, labor-intensive therapies to a few regional centers. This model is based on the reduction of morbidity and mortality for trauma patients at designated trauma centers.2,3 Because patients in need of specialized services often present to other hospitals, interfacility transport is an important complement to regionalized intensive care.4 Specialized pediatric transport services improve safety, decrease unplanned adverse events (especially airway events), and lower mortality.4-6 This chapter reviews the general and pediatric considerations for the interfacility transport of critically ill neonates and children.
Caring for critically ill children is best accomplished with at least two patient care providers on each team in addition to the driver or pilot. One of the patient care members should be a registered nurse with a minimum of 5 years of experience, typically at least 3 years of neonatal or pediatric critical care or ED training.4 Additional member(s) may include a respiratory therapist, physician, or paramedic. The condition of the child and local resources determine the exact composition of the specialized transport team.
Transporting critically ill patients adds to the risks of the illness or injury because of the hazards associated with the transport environment, particularly for neonates and children.7 The features of transport that distinguish the transport environment from the ED setting and the effects of these features on patients and caretakers are outlined in Table 105-1.
Table 105-1 Features of Transport versus Inpatient Setting and Effect |Favorite Table|Download (.pdf)
Table 105-1 Features of Transport versus Inpatient Setting and Effect
Reach levels 90–110 dB8,9
Arterial desaturation in infants
Inability to auscultate
Monitors to allow visual cues
Autonomic/central nervous system motion-induced illness (sopite, nausea syndromes)
Equipment motion artifact
Ondansetron, gastric decompression
Poor visual cues
Complications with procedures
Compartmental lighting 400 lux
Task lighting 1000–1500 lux
Gradient-dependent heat loss by convection and radiation
Limiting time in transport
Thermal regulation of vehicles and surfaces
Double-walled isolettes for neonates and infants
Nonhumidification of respiratory gases causes dehydration, secretion tenacity
Humidify gases for long (>2 h) transports
Expansion of gases in closed spaces
Significant for nonpressurized aircraft above 5000 ft (1500 m)
Ventilate closed-space gas to atmosphere
Orogastric tube, decompress pneumothorax
Limits crew, workspace, equipment
Typical sizes: 47 sq. ft (ambulance) 22–36 sq. ft (helicopter) 150 sq. ft (neonatal intensive care unit patient space)
Efficient use of patient care space in vehicle
Hospital-based radiographic and laboratory services unavailable
No onsite additional clinical expertise
Portable blood analyzer (i-STAT®)
Thoughtful planning of radiographic needs
Consultants via telecommunications
Exhaustion of respiratory gases, supplies, medications
Monitor deterioration secondary to vibration
Thorough supply checks
Routine accelerated maintenance schedule
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