Regionalization, the organization of a coordinated system of care across a geographic area, combines all necessary components of care to optimize patient outcomes. Regionalized intensive care for neonatology and pediatric care1 focuses expensive, high-technology, labor-intensive therapies to a few regional centers. This model of care originated from trauma center regionalization demonstrating 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, 5, 6 This chapter reviews the general and pediatric considerations for the interfacility transport of critically ill neonates and children.
The American Academy of Pediatrics has published transport guidelines based on expert consensus.7 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. For helicopter EMS transports, the most common care arrangement involves a paramedic and neonatal or pediatric care nurse in addition to the pilot. Similar arrangements of one paramedic and a critical care nurse or two critical care nurses with neonatal and pediatric expertise are frequently used for ground transports. Accreditation agencies and professional associations will guide local and regional team compositions.
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.8 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 Chapter 3, “Air Medical Transport.” All the risks of transport still apply, with the additional need for awareness of the emotional and mental state of the child. Also, since one parent often accompanies the child, additional weight considerations must be accounted for during aeromedical transport.
Suggested guidelines to minimize the impact of the limitations inherent in a transport environment are:
Prepare the transport vehicle. Transport vehicles should be prepared to meet the special needs of children (e.g., accessory lighting, controlled thermal environment) and should be stocked with the necessary equipment. A list of the minimum necessary equipment for ambulances, which can serve as a guide for EMS agencies, has been published by the Emergency Medical Services ...