The optimal transport of each neonatal and pediatric patient is facili­tated when the personnel involved ensure the appropriate use of available resources, including staff, equipment, and vehicles.

An increased awareness of transfer requirements has been highlighted by the federal Emergency Medical Treatment and Active Labor Act (EMTALA [42 USC §1395dd]), which requires that all transfers be effected using qualified personnel and transportation equipment.

The selection of the most appropriate mode (vehicle) for neonatal- pediatric transport is influenced by numerous factors. The acuity and sta­bility of the patient's condition and the need for unavailable local services (ie, a higher level of care) have major roles. Vehicle availability, weather, dis­tance, geography, transport time, and transport “logistics” are also essential considerations. Transport logistics include the potential advantages and dis­advantages of the various modes of transport.

Vehicles used in patient transport include surface (ground) and air ambulances. Air ambulances are rotor-wing (helicopter) or fixed-wing (airplane) aircraft. The transfer of a neonatal or pediatric patient between facilities may require one or a combination of these vehicles. Transport teams and program administrators commonly determine which of these vehicles best fits their particular mission profile. A fully integrated trans­port system would include all 3 mode types as options. At the time of a transport request, a triage decision should be made to determine the most appropriate vehicle (or combination of vehicles) for the particular mission. Unfortunately, but realistically, many transport teams have limited resources. Although it may be common for transport programs that serve large rural areas to provide helicopter and airplane transport, they may do few (if any) nonair transports. In these circumstances, the transports may be outsourced or coordinated with a program that provides ground transports.

Patient transfers may be 1-way, when a vehicle is dispatched directly from the referring facility to the receiving facility; however, for neonatal- pediatric transport, the transfer more commonly is 2-way, in which the vehicle and specialized transport team members are sent from the receiving facility to the referring facility to pick up the patient. In addition, transports also can be 3-way, in which a transport vehicle and team from neither the referring nor the receiving facility are requested to undertake the transport. Private ambulance companies (air and ground) and most community- or hospital-sponsored air-medical flight programs perform such 3-way transfers as needed or under the terms of an established transport agreement.

Vehicle purchasing and leasing decisions should be made with direct input from people who are knowledgeable about the transport environment and the capability of the various vehicles. The planning group should include members of the transport team who are directly and routinely involved in transport decisions. The items presented in this chapter usually are consid­ered when administrative and transport personnel decide which vehicle(s) will best fit the goals of their program.