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High-Yield Facts

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  • Outcomes for critically ill and injured children improve when treatment is provided by skilled pediatric specialist transport teams.

  • Appropriate medical care for any patient with an emergent condition should never be delayed because of inability to find a caregiver or guardian to give consent for treatment.

  • The referring physician is responsible for stabilizing the patient's condition, within the capabilities of the referring institution, before the patient is transferred to another institution.

  • Limitation of resuscitation orders (DNR) may be revoked at any time according to the parents or legal guardians' wishes.

  • Composition of team personnel is driven by the needs of the patient being transported.

  • Transport personnel must be familiar with their protocols and the limitations and responsibilities of their specific profession's scope of practice.

  • A quality management program is essential for a well-run transport service.

  • Stresses of flight affect both the patient and crew members and should always be taken into consideration when transporting a patient.

  • At high altitude, a child may become hypoxic and pneumothoraxes can expand.

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Historical Perspectives

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Specialized transport systems have evolved from military conflicts; the earliest references date from the Napoleonic wars. The first reported transport of a patient via aircraft took place in 1915; and the helicopter saw its first use in air medical transport in Burma in 1944.1 Development of specialized pediatric transport teams began in the 1970s with the establishment of neonatal intensive care units. The need for rapid and safe transport of critically ill and injured children has driven the formation of specialized pediatric transport teams to improve outcomes when treatment is provided by skilled pediatric specialists.

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Legal Considerations

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Interfacility
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Approximately 2% to 3% of all children seeking treatment in an emergency department (ED) are not accompanied by a parent or legal guardian. All efforts to obtain consent for treatment and transfer of a pediatric patient should be made and documented, but appropriate medical care for the patient with an urgent or emergent condition, including transport, should never be withheld or delayed because of problems obtaining consent.

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Federal law under the Emergency Medical Treatment and Active Labor Act (EMTALA) mandates a medical screening for every patient seeking treatment in an ED of any hospital that participates in programs that seek federal funding, regardless of reimbursement considerations. EMTALA mandates therapy for emergency medical conditions up to and including surgical intervention.2 If definitive care cannot be rendered at the local hospital, the patient should be transferred to a hospital that has the resources and capabilities to care for the patient. Prior to transfer, the referring physician is responsible for stabilizing the patient's condition within the capabilities of the referring institution, initiating transfer and selecting the mode of transport, and ensuring that the receiving facility is able to deliver the necessary care and agrees to accept the transfer.3 The transport team should ...

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