In many countries, pediatric medical and surgical specialty services are regionalized to either community hospitals or tertiary and quaternary pediatric centers. Thus, critically ill children in need of these services may need to be transported considerable distances from their home communities in order to receive higher levels of care.
The main goal of successful patient transport is to transfer the patient to definitive care while preventing further deterioration. In order to achieve this goal, close monitoring, continued resuscitation, and time sensitive treatments may be necessary. However, there are inherent risks related to the transport, such as exposure to weather-related hazards, transport vehicle mishaps, and difficulties with patient monitoring and assessment due to the noisy, cramped, moving environment. In order to mitigate these risks and optimize patient care, there are many measures that can be taken. First, prompt telephone or video conferencing with specialized pediatric healthcare providers can guide patient management decisions and ensure that urgent medical interventions are initiated. Second, early discussion enables mobilization of resources and decisions on the appropriate mode of transportation. These discussions should address what equipment will be required in order to adequately and efficiently prepare for transport. Third, selecting the appropriate healthcare team to accompany the patient is imperative. The transport of critically ill children and neonates by specialized pediatric and neonatal transport teams has resulted in fewer adverse events and improved outcomes than those transported by providers without this specialized training. Given that most specialized teams are located in central areas, the time it takes for retrieval teams to reach the patient must be factored into the total transport time, and thus furthers the argument that prompt referral for transport is imperative. In the following, we will discuss important considerations of stabilization and transfer, including the timing of referral, who to refer, and how to mitigate the risk of transport.
PATHOGENESIS AND EPIDEMIOLOGY
When Is Patient Transport Necessary?
Generally, patients are transported from one facility to another to receive a higher level of care based on their medical diagnosis and on their diagnostic and treatment requirements. Decisions regarding when and where to transfer a patient are based on the local and regional resource availability, as well as patient acuity. Due to the centralization of specialized services, some children also may be transported electively for routine outpatient appointments. Patients that present to remote nursing stations or hospitals without the ability to admit pediatric patients may require semi-urgent transfer to seek general pediatric expertise. Other patients may require urgent and emergent transfer to tertiary or quaternary hospitals for specialized diagnostic or surgical services, subspecialty evaluation, or admission to a neonatal intensive care unit (NICU) or pediatric intensive care unit (PICU).
Selecting the Optimal Mode of Transport
Local resources and infrastructure determine the mode of transport used to transfer children. In developing countries, patients ...