Background and Principles of Neonatal-Pediatric Interfacility Transport

For many critically ill or injured patients, particularly those being treated at institutions that are unable to provide the level of care required, access to a skilled transport team is essential.

Regionalization of neonatal and pediatric intensive and specialty care services has driven the development of specialized transport programs that facilitate the safe transfer of infants and children between community and tertiary care facilities. In the United States, hospital-based neonatal transport programs were first created in the 1960s and 1970s, and similar programs for pediatric patients emerged in the 1980s. Whereas most neonatal and pedi­atric transport programs are affiliated with nonprofit tertiary care receiving institutions, there are a growing number of for-profit stand-alone aeromedi­cal transport services with variable neonatal and pediatric expertise.

The period when a critically ill or injured infant or child is traveling between institutions represents a particularly vulnerable time for the patient. A qualified, highly trained, and well-prepared and equipped team is the key to providing optimal care during interfacility transport and to preventing deterioration or adverse events. All transitions of care must be seamless. The level of care and monitoring should not be significantly compromised by the need to travel between facilities. Ideally, the patient's condition may even improve because of therapies recommended by the medical command physi­cian or initiated by the transport team, which might otherwise not be avail­able until after arrival at the receiving hospital.

Before leaving the referring facility, thoughtful consideration must be given to the benefits and risks of specific interventions. This approach differs from the ‘swoop and scoop' practice sometimes used during the prehospital transport of a patient from an accident scene to an emergency department (ED). Most neonatal and pediatric patients benefit more from a carefully coordinated and anticipated transport — with critical care therapies provided both before and throughout the transport, as necessary — than from a hasty transfer. The exceptions are patients with certain conditions, such as surgical emergencies, who require rapid access to services not available at the refer­ring hospital or during the transport itself. An example is a child with an expanding intracranial hemorrhage who presents to an institution without neurosurgical capabilities.