Skip to main content
SpringerLink
Log in

Transport of Sick Infants and Children

  • Living reference work entry
  • First Online:
Pediatric Surgery

Abstract

Due to centralization and resource optimization, treatment of severely ill children and patients with complex diseases can only be provided in highly specialized tertiary centers . To ensure an optimal care, sick children must therefore be transported safely to these hospitals, sometimes over considerable distances. The transport modus should fulfill the special needs of the pediatric and neonatal patients with its unique anatomic and physiologic conditions requiring trained and skilled staff and specially equipped vehicles. Field triage is needed to discriminate between the more- and less-severely injured and find the optimal mode of transport.

Transport team and vehicle should be an extension of the pediatric or neonatal intensive care unit, able to supply the technical facilities for advanced critical care management for children of all ages in the area of primary care and during transport to the hospital.

During the past two decades, the approach of pediatric transport care has changed dramatically considering the knowhow, capabilities, and transportation of neonates, infants, and older children. This chapter aims to describe current considerations regarding the different transportation modalities and age-dependent requirements.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution

Institutional subscriptions

References

  • Ajizian SJ, Nakagawa TA. Interfacility transport of the critically ill pediatric patient. Chest. 2007;132(4):1361–7.

    Article  PubMed  Google Scholar 

  • Borrows EL, Lutman DH, Montgomery MA, Petros AJ, Ramnarayan P. Effect of patient- and team-related factors on stabilization time during pediatric intensive care transport. Pediatr Crit Care Med. 2010;11(4):451–6.

    PubMed  Google Scholar 

  • Bosch J, de Nooij J, de Visser M, Cannegieter SC, Terpstra NJ, Heringhaus C, et al. Prehospital use in emergency patients of a laryngeal mask airway by ambulance paramedics is a safe and effective alternative for endotracheal intubation. Emerg Med J. 2014;31(9):750–3.

    Article  CAS  PubMed  Google Scholar 

  • Broman LM, Holzgraefe B, Palmer K, Frenckner B. The Stockholm experience: interhospital transports on extracorporeal membrane oxygenation. Crit Care. 2015;19:278.

    Article  PubMed  PubMed Central  Google Scholar 

  • Brown JB, Leeper CM, Sperry JL, Peitzman AB, Billiar TR, Gaines BA, et al. Helicopters and injured kids: improved survival with scene air medical transport in the pediatric trauma population. J Trauma Acute Care Surg. 2016;80(5):702–10.

    Article  PubMed  PubMed Central  Google Scholar 

  • Bryner B, Cooley E, Copenhaver W, Brierley K, Teman N, Landis D, et al. Two decades’ experience with interfacility transport on extracorporeal membrane oxygenation. Ann Thorac Surg. 2014;98(4):1363–70.

    Article  PubMed  Google Scholar 

  • Calhoun A, Keller M, Shi J, Brancato C, Donovan K, Kraus D, et al. Do pediatric teams affect outcomes of injured children requiring inter-hospital transport? Prehosp Emerg Care. 2017;21(2):192–200.

    Google Scholar 

  • Chang AS, Berry A, Jones LJ, Sivasangari S. Specialist teams for neonatal transport to neonatal intensive care units for prevention of morbidity and mortality. Cochrane Database Syst Rev. 2015;10:CD007485.

    Google Scholar 

  • Chassery C, Bouchut JC, Blaise BJ, Courtil-Teyssedre S, Gueugniaud PY. Ventilation of severe bronchiolitis in interhospital transport: a place for high frequency oscillatory ventilation? Paediatr Anaesth. 2015;25(6):643–4.

    Article  PubMed  Google Scholar 

  • Cowley RA, Hudson F, Scanlan E, Gill W, Lally RJ, Long W, et al. An economical and proved helicopter program for transporting the emergency critically ill and injured patient in Maryland. J Trauma. 1973;13(12):1029–38.

    Article  CAS  PubMed  Google Scholar 

  • Cushman JT, Fairbanks RJ, O’Gara KG, Crittenden CN, Pennington EC, Wilson MA, et al. Ambulance personnel perceptions of near misses and adverse events in pediatric patients. Prehosp Emerg Care. 2010;14(4):477–84.

    Article  PubMed  PubMed Central  Google Scholar 

  • Drayna PC, Browne LR, Guse CE, Brousseau DC, Lerner EB. Prehospital pediatric care: opportunities for training, treatment, and research. Prehosp Emerg Care. 2015;19(3):441–7.

    Article  PubMed  Google Scholar 

  • Edge WE, Kanter RK, Weigle CG, Walsh RF. Reduction of morbidity in interhospital transport by specialized pediatric staff. Crit Care. 1994;22(7):1186–91.

    Article  CAS  Google Scholar 

  • Fenton AC, Leslie A. Who should staff neonatal transport teams? Early Hum Dev. 2009;85(8):487–90.

    Article  PubMed  Google Scholar 

  • Fenton SJ, Lee JH, Stevens AM, Kimbal KC, Zhang C, Presson AP, et al. Preventable transfers in pediatric trauma: a 10-year experience at a level I pediatric trauma center. J Pediatr Surg. 2016;51(4):645–8.

    Article  PubMed  Google Scholar 

  • Foronda C, VanGraafeiland B, Quon R, Davidson P. Handover and transport of critically ill children: an integrative review. Int J Nurs Stud. 2016;62:207–25.

    Article  PubMed  Google Scholar 

  • Freeman JF, Ciarallo C, Rappaport L, Mandt M, Bajaj L. Use of capnographs to assess quality of pediatric ventilation with 3 different airway modalities. Am J Emerg Med. 2016;34(1):69–74.

    Article  PubMed  Google Scholar 

  • Gajendragadkar G, Boyd JA, Potter DW, Mellen BG, Hahn GD, Shenai JP. Mechanical vibration in neonatal transport: a randomized study of different mattresses. J Perinatol. 2000;20(5):307–10.

    Article  CAS  PubMed  Google Scholar 

  • Garwe T, Johnson JJ, Letton RW. Indication bias explains some of the observed increased mortality associated with use of prehospital intravenous fluids in a pediatric trauma population. Acad Emerg Med. 2016;23(1):83–92.

    Article  PubMed  Google Scholar 

  • Gillick J, Puri P. Pre-operative managment and vascular access. In: Puri P, Höllwarth ME, editors. Pediatric surgery: diagnosis and management. Berlin: Springer; 2009. p. 27–38.

    Chapter  Google Scholar 

  • Goldsmit G, Rabasa C, Rodriguez S, Aguirre Y, Valdes M, Pretz D, et al. Risk factors associated to clinical deterioration during the transport of sick newborn infants. Arch Argent Pediatr. 2012;110(4):304–9.

    PubMed  Google Scholar 

  • Gunz AC, Dhanani S, Whyte H, Menon K, Foster JR, Parker MJ, et al. Identifying significant and relevant events during pediatric transport: a modified Delphi study. Pediatr Crit Care Med. 2014;15(7):653–9.

    Article  PubMed  Google Scholar 

  • Hewes H, Hunsaker S, Christensen M, Whitney J, Dalrymple T, Taillac P. Documentation of pediatric vital signs by EMS providers over time. J Pediatr Surg. 2016;51(2):329–32.

    Article  PubMed  Google Scholar 

  • Holcomb JB, Wade CE, Brasel KJ, Vercruysse G, MacLeod J, Dutton RP, et al. Defining present blood component transfusion practices in trauma patients: papers from the trauma outcomes group. J Trauma. 2011;71(2 Suppl 3):S315–7.

    Article  PubMed  Google Scholar 

  • Holt PL, Hodge AB, Ratliff T, Frazier WJ, Ohnesorge D, Gee SW. Pediatric extracorporeal membrane oxygenation transport by EC-145 with a custom-built sled. Air Med J. 2016;35(3):171–5.

    Article  PubMed  Google Scholar 

  • International Electrotechnical Commission. IEC 60601-2-19, IEC 60601-2-20: particular requirements for the basic safety and essential performance of infant incubators. 2nd ed. 2009.

    Google Scholar 

  • Jackson L, Skeoch CH. Setting up a neonatal transport service: air transport. Early Hum Dev. 2009;85(8):477–81.

    Article  PubMed  Google Scholar 

  • Jones D, Hansen M, van Otterloo J, Dickinson C, Guise JM. Emergency medical services provider pediatric adverse event rate varies by call origin pediatric emergency care. Pediatr Emerg Care. 2016. [Epub ahead of print].

    Google Scholar 

  • Joyce CN, Libertin R, Bigham MT. Family-centered care in pediatric critical care transport. Air Med J. 2015;34(1):32–6.

    Article  PubMed  Google Scholar 

  • Koch J. Transport incubator equipment. Semin Neonatol. 1999;4(4):241–5.

    Article  Google Scholar 

  • Larsen GY, Mecham N, Greenberg R. An emergency department septic shock protocol and care guideline for children initiated at triage. Pediatrics. 2011;127(6):e1585–92.

    Article  PubMed  Google Scholar 

  • Leslie AJ, Stephenson TJ. Audit of neonatal intensive care transport – closing the loop. Acta Paediatr. 1997;86(11):1253–6.

    Article  CAS  PubMed  Google Scholar 

  • Lloyd DA. Transfer of the surgical newborn infant. Semin Neonatol. 1996;1(3):241–8.

    Article  Google Scholar 

  • Long MT, Cvijanovich NZ, McCalla GP, Flori HR. Changes in pediatric-sized endotracheal tube cuff pressure with elevation gain: observations in ex vivo simulations and in vivo air medical transport. Pediatr Emerg Care. May 21 2016. [Epub ahead of print].

    Google Scholar 

  • Lowe CG, Trautwein JG. Inhaled nitric oxide therapy during the transport of neonates with persistent pulmonary hypertension or severe hypoxic respiratory failure. Eur J Pediatr. 2007;166(10):1025–31.

    Article  CAS  PubMed  Google Scholar 

  • Macdonald ME, Liben S, Carnevale FA, Cohen SR. An office or a bedroom? Challenges for family-centered care in the pediatric intensive care unit. J Child Health Care. 2012;16(3):237–49.

    Article  PubMed  Google Scholar 

  • Mainali ES, Greene C, Rozycki HJ, Gutcher GR. Safety and efficacy of high-frequency jet ventilation in neonatal transport. J Perinatol. 2007;27(10):609–13.

    Article  CAS  PubMed  Google Scholar 

  • McCall EM, Alderdice FA, Halliday HL, Jenkins JG, Vohra S. Interventions to prevent hypothermia at birth in preterm and/or low birthweight infants. Cochrane Database Syst Rev. 2008;1:CD004210.

    Google Scholar 

  • McHugh P, Stringer M. Transport of sick infants and childre. In: Atwell JD, editor. Paediatric surgery. New York: Oxford University Press; 1998. p. 73–89.

    Google Scholar 

  • Messner H. Neonatal transport: a review of the current evidence. Early Hum Dev. 2011;87(Suppl 1):S77.

    Article  PubMed  Google Scholar 

  • Meyer MT, Gourlay DM, Weitze KC, Ship MD, Drayna PC, Werner C, et al. Helicopter interfacility transport of pediatric trauma patients: are we overusing a costly resource? J Trauma Acute Care Surg. 2016a;80(2):313–7.

    Article  PubMed  Google Scholar 

  • Meyer MT, Mikhailov TA, Kuhn EM, Collins MM, Scanlon MC. Pediatric specialty transport teams are not associated with decreased 48-hour pediatric intensive care unit mortality: a propensity analysis of the VPS. LLC Database Air Med J. 2016b;35(2):73–8.

    Article  PubMed  Google Scholar 

  • Michailidou M, Goldstein SD, Salazar J, Aboagye J, Stewart D, Efron D, et al. Helicopter overtriage in pediatric trauma. J Pediatr Surg. 2014;49(11):1673–7.

    Article  PubMed  Google Scholar 

  • Moss SJ, Embleton ND, Fenton AC. Towards safer neonatal transfer: the importance of critical incident review. Arch Dis Child. 2005;90(7):729–32.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Mullaney DM, Edwards WH, DeGrazia M. Family-centered care during acute neonatal transport. Adv Neonatal Care. 2014;14(Suppl 5):S16–23.

    Article  PubMed  Google Scholar 

  • Odetola FO, Mann NC, Hansen KW, Bratton SL. Factors associated with time to arrival at a regional pediatric trauma center. Prehosp Dis Med. 2016;31(1):4–9.

    Article  Google Scholar 

  • Orr RA, Felmet KA, Han Y, McCloskey KA, Dragotta MA, Bills DM, et al. Pediatric specialized transport teams are associated with improved outcomes. Pediatrics. 2009;124(1):40–8.

    Article  PubMed  Google Scholar 

  • Orsborn J, Graham J, Moss M, Melguizo M, Nick T, Stroud M. Pediatric endotracheal tube cuff pressures during aeromedical transport. Pediatr Emerg Care. 2016;32(1):20–2.

    Article  PubMed  Google Scholar 

  • Patel S, Hertzog JH, Penfil S, Slamon N. A prospective pilot study of the use of telemedicine during pediatric transport: a high-quality, low-cost alternative to conventional telemedicine systems. Pediatr Emerg Care. 2015;31(9):611–5.

    Article  PubMed  Google Scholar 

  • Piira T, Sugiura T, Champion GD, Donnelly N, Cole AS. The role of parental presence in the context of children’s medical procedures: a systematic review. Child Care Health Dev. 2005;31(2):233–43.

    Article  CAS  PubMed  Google Scholar 

  • Puri P, Doodnath R. Transport of the surgical neonate. In: Puri P, editor. Newborn surgery 3E. London: CRC Press; 2011. p. 83–90.

    Google Scholar 

  • Quinn JM, Pierce MC, Adler M. Factors associated with mode of transport decision making for pediatric-neonatal interfacility transport. Air Med J. 2015;34(1):44–51.

    Article  PubMed  Google Scholar 

  • Ramnarayan P, Thiru K, Parslow RC, Harrison DA, Draper ES, Rowan KM. Effect of specialist retrieval teams on outcomes in children admitted to paediatric intensive care units in England and Wales: a retrospective cohort study. Lancet. 2010;376(9742):698–704.

    Article  PubMed  Google Scholar 

  • Ratnavel N. Safety and governance issues for neonatal transport services. Early Hum Dev. 2009;85(8):483–6.

    Article  PubMed  Google Scholar 

  • Schwartz HP, Bigham MT, Schoettker PJ, Meyer K, Trautman MS, Insoft RM. Quality metrics in neonatal and pediatric critical care transport: a National Delphi Project. Pediatr Crit Care Med. 2015;16(8):711–7.

    Article  PubMed  Google Scholar 

  • Seegobin RD, van Hasselt GL. Endotracheal cuff pressure and tracheal mucosal blood flow: endoscopic study of effects of four large volume cuffs. Br Med J (Clin Res Ed). 1984;288(6422):965–8.

    Article  CAS  Google Scholar 

  • Stewart CL, Metzger RR, Pyle L, Darmofal J, Scaife E, Moulton SL. Helicopter versus ground emergency medical services for the transportation of traumatically injured children. J Pediatr Surg. 2015;50(2):347–52.

    Article  PubMed  Google Scholar 

  • Stroud MH, Prodhan P, Moss MM, Anand KJS. Redefining the golden hour in pediatric transport. Pediatr Crit Care Med. 2008;9(4):435–7.

    Article  PubMed  Google Scholar 

  • Stroud MH, Trautman MS, Meyer K, Moss MM, Schwartz HP, Bigham MT, et al. Pediatric and neonatal interfacility transport: results from a national consensus conference. Pediatrics. 2013;132(2):359–66.

    Article  PubMed  Google Scholar 

  • Stroud MH, Sanders RCJR, Moss MM, Sullivan JE, Prodhan P, Melguizo-Castro M, et al. Goal-directed resuscitative interventions during pediatric interfacility transport. Crit Care Med. 2015;43(8):1692–8.

    Article  PubMed  PubMed Central  Google Scholar 

  • Zebrack M, Dandoy C, Hansen K, Scaife E, Mann NC, Bratton SL. Early resuscitation of children with moderate-to-severe traumatic brain injury. Pediatrics. 2009;124(1):56–64.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. National Children’s Research Centre, Our Lady’s Children’s Hospital, Crumlin, Dublin 12, Ireland

    Julia Zimmer & Prem Puri

  2. School of Medicine and Medical Science, Conway Institute of Biomedical Research, University College Dublin, Crumlin, Dublin 12, Ireland

    Prem Puri

  3. Department of Pediatric Surgery, Hannover Medical School, Hannover, Germany

    Julia Zimmer

Authors
  1. Julia Zimmer
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Prem Puri
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Prem Puri .

Editor information

Editors and Affiliations

  1. Our Lady’s Children's Hospital, National Children’s Research Centre, Dublin, Ireland

    Prem Puri

Rights and permissions

Reprints and permissions

Copyright information

© 2017 Springer-Verlag GmbH Germany

About this entry

Cite this entry

Zimmer, J., Puri, P. (2017). Transport of Sick Infants and Children. In: Puri, P. (eds) Pediatric Surgery. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-38482-0_11-1

Download citation

  • DOI: https://doi.org/10.1007/978-3-642-38482-0_11-1

  • Received:

  • Accepted:

  • Published:

  • Publisher Name: Springer, Berlin, Heidelberg

  • Print ISBN: 978-3-642-38482-0

  • Online ISBN: 978-3-642-38482-0

  • eBook Packages: Springer Reference MedicineReference Module Medicine

Publish with us

Policies and ethics

Search

Navigation