Whether initiated in a primary care office, an emergency room,
or a hospital, the preparations for transport always start with
the recognition and summary evaluation of the patient’s
problem. Every clinician should ideally be prepared to recognize,
diagnose, and begin treatment for life-threatening respiratory,
circulatory, and neurological impairments (see Chapters 102, 103, and 104).
Often this can be done with remote consultation from the appropriate
specialists (eg, critical care medicine, neonatology, or cardiology)
once a referral center is selected, but nothing can replace the
careful, calm assessment of a capable clinician with direct access
to the patient. When such distant consultations are established,
it is important that the two parties have an explicit understanding
of their responsibility for the individual’s care.2-5