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HIGH-YIELD FACTS

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

  • The needs of the patient being transported should drive the composition of the team.

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

  • 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 (“Do Not Resuscitate” [DNR]) may be revoked at any time according to the parents’ or legal guardians’ wishes.

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

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

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

HISTORICAL PERSPECTIVES

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 neonatal and pediatric transport teams that have demonstrated improved patient outcome. Recently, quality improvement initiatives have led to the development of the Ground and Air Medical Quality Transport (GAMUT) database in 2014 to track, report, and analyze transport programs.

LEGAL CONSIDERATIONS

INTERFACILITY

Federal law under the Emergency Medical Treatment and Active Labor Act (EMTALA) mandates a medical screening for every patient seeking treatment in an emergency department (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 accepts the transfer.3 It is recommended that all treatment facilities have interfacility transfer agreements and guidelines to ensure timely and appropriate transfer of patients to the appropriate level of emergency care. The transport team should be aware of any limitation of resuscitation orders that may be in place, especially in the case of a chronically ill child. If special state out-of-hospital “Do Not Resuscitate” orders (DNR) exist, they should be discussed with the medical control physician before transporting the child ...

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