Sick or injured children may initially be taken to a unit which can offer adequate resuscitation or stabilisation but is unable to offer further acute or long-term medical management. Such children must be transported to another hospital or department. Critically ill children transferred by untrained personnel have been shown to suffer largely preventable transfer-related morbidity. In the United Kingdom a standard of practice for the transport of critically ill children has been set by the Paediatric Intensive Care Society. This may involve specialised paediatric transfer teams which are usually based at a paediatric intensive care unit. These teams can be contacted in the event of requests for transfer of a child to a paediatric intensive care facility or specialised facility such as a neurosurgical or burns unit. Often a patient needs to be transported from the Emergency department to another department within the same hospital. Not surprisingly, such transfers are also associated with a high incidence of serious transport-related adverse events.
The basic principles of good transport should be applied to all sick children moved within or between hospitals, whether or not a specialised team is involved.
It is essential to evaluate, resuscitate and stabilise a child's condition before moving him or her. Whatever the injury or illness the airway must be secured and ventilation must be adequate. Intravenous access must be established and fluids and/or life-saving drugs given. Proper evaluation requires a thorough examination to show whether any orthopaedic, surgical or medical procedures should be carried out prior to transportation. Baseline haematological and biochemical samples should be taken when the intravenous lines are placed and essential imaging should be carried out at this time.
The staff at the receiving hospital or department must be contacted prior to arranging transport. They must be clearly told what has happened, the state of the child, the treatment received and what transport facilities and staff are needed. Both teams can then decide if the child is stable enough for transport and whether the referring or receiving hospital will provide the staff to supervise transfer.
Joint management by the referring hospital and transport team should commence immediately since successful initial resuscitation and stabilisation is crucial to ultimate outcome. It must be stressed that this initial role is, and must remain, the responsibility of the referring unit and should be provided at a senior level in conjunction with advice given by the receiving hospital staff.
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