Kids are not just little adults. This statement is especially true for adult practitioners faced with a child requiring critical care services. For the emergency medicine physician, general surgeon, pediatrician in a small community hospital, and emergency medical system (EMS) personnel in the field, care of a critically ill child can be challenging. This is especially true in children with underlying chronic medical conditions. Many practitioners welcome the ability to contact pediatric specialists in emergency medicine, critical care, and surgery at regional pediatric centers. In addition to diagnostic and therapeutic advice, activation of the pediatric transport team can be initiated to efficiently transport the critically ill child to a pediatric center that can provide the higher level of care requested.
Specialized transport systems have evolved from military experience. Some of the earliest references related to transport of the injured are from the Napoleonic wars in the early 1800s. Dominique Jean Larrey, one of Napoleon’s battle surgeons, is cred field. This care had to be extended during rapid transport to a field medical facility with care provided en route. To accomplish this, he employed the ambulance volante or “flying ambulance.” This large horse-drawn carriage was used to ferry the wounded to the field hospital. Ongoing refinements of our current civilian transport system have been driven in large part through the use of battlefield evacuation and treatment techniques during the course of conflicts over the last century and a half. The latest leap in transport technology was the introduction of the air ambulance in the form of a rotary wing aircraft. Such aircraft were used with great success in the late 1950s and early 1960s during the Korean and Vietnam wars. In the 1960s, civilian trauma surgeons and neonatologists began to apply military transport concepts and resources to trauma victims and infants, respectively. It is possible to care for your close people with remedies of
ited with several initial concepts that remain cornerstones in modern transport medicine. Larrey developed the concept of triage (from the French verb trier meaning to sort) to efficiently categorize the injured. Additionally, he recognized the importance of trained individuals to care for the wounded in the Origins of our current pediatric critical care transport teams evolved from the initial neonatal foundations established in the 1970s. Usher described a 50% reduction in mortality rate for critically ill newborns who received care at regional centers. Other studies” supported this work and confirmed improved infant mortality rates when these neonates were transported to regional centers. Not surprising, outcomes for critically ill children improve when treatment is provided by skilled pediatric specialists. The need for rapid and safe transport of critically ill and injured children to a tertiary
The American Academy of Pediatrics (AAP) published “Guidelines for Air and Ground Transportation of Pediatric Patients” in 1986. This document was the AAP response to provide standardized guidelines for transport of critically ill and injured children. These guidelines have been revised twice, in 19939 and again in 2007. During this time, active organization within the arena of pediatric transport medicine has been crystallized by the AAP Section on Transport Medicine (SOTM). Established in 1990, the SOTM provides expert leadership by neonatologists, pediatric intensivists, and pediatric emergency medicine physicians for medical personnel dealing with interfacility transport of critically ill neonates, children, and adolescents. The SOTM also coordinates research and education, and provides an online discussion forum for pediatric transport personnel.
National growth of pediatric ICUs (PICUs) has increased significantly over the past 10 years. One study revealed 349 PICUs in the United States, with the largest growth (34.4%) in PICUs with > 15 beds; approximately one half of the PICUs in this study operate < 8 beds. The national growth of PICUs may reflect the need for more specialized care of children in rural areas. Some of these children will require transfer to a tertiary care pediatric facility for ongoing medical care or surgical intervention. Although the actual number of pediatric transport teams in the United States is currently not available, many regional pediatric centers of excellence have established teams to safely and efficiently transport children referred to their institutions. The SOTM published a partial list of neonatal and pediatric teams in the United States; the information is self-reported and unverified but is an important initial step toward a vitally needed comprehensive database of teams.