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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.4,5,6 This chapter reviews the general and pediatric considerations for the interfacility transport of critically ill neonates and children.
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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.
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TRANSPORT ENVIRONMENT
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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 107-1.
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