TRANSPORT OF SICK CHILD

Although developed countries have separate critical- care teams for transport of sick children from the site of emergency or primary care to nearest pediatric intensive care units (PICUs) or tertiary trauma centers, such facilities are almost non-existent in India.

a. Advance notification to the nearest PICU or trauma center on phone, with complete information regarding patient's cardiopulmonary status, suspected cause of injury/indication for transfer and the expected time of arrival at receiving unit. Consent of the receiving unit, along with the name of contact person should also be obtained prior to transfer. Copy of all patient records, including laboratory reports should accompany the patient for review by receiving unit.

b. Pre-transport stabilization with BLS measures as discussed earlier. As far as possible, the patient should be transported with a secure venous access for fluids/drugs administration during transport. It is also necessary to ensure an adequate and patent airway, along with best possible ventilatory support, e.g. oxygen or bag/mask ventilation, before transport.

Children with suspected spinal injuries need adequate splint immobilization to avoid aggravation of injury.

c. Mode of transport: Choice for the mode of transport depends on urgency, patient's status, travel-distance and feasibility. Unlike developed countries, where air transport of sick cases is frequently available, road transport is the norm in India, using hospital ambulances. All tertiary care centers are expected to have a well-equipped ambulance for pickup and transfer of critically sick children. Some non­governmental organizations also provide such facilities on humanitarian or payment basis.

As most of these vehicles are usually designed and equipped for adult transport, it is important to ensure adequate supply of essential drugs and equipment, e.g.

d. Experienced transport team: Unlike specially trained transport teams in developed countries, critically sick children in India are usually accompanied by paramedical personals with a little experience in pediatric resuscitation. Hence, It is desirable that a trained pediatric staff accompanies the patient during transfer, well-experienced in at least BLS measures.

e. Actual transport: A baby should be constantly monitored during transport for vital signs and need for resuscitative procedures, by accompanying medical/paramedical person. However, as actual resuscitation is often difficult in a moving transport vehicle, the aim should be to use shortest and fastest route to minimize patient's distress and need for resuscitative procedures.

f. Acceptance of transfer: Receiving unit, pre-informed by referring unit, must be well-prepared to accept the case on arrival with appropriate administrative formalities, suitable intra-hospital transport, e.g. stretchers and resuscitative equipments. Accom­panying person should supply details of patient's status during transport as well as medical records from referring unit.

g. Post-transport follow-up: The referring unit should be contacted by receiving unit to inform status of the patient on arrival and enquire about further medical details. The receiving unit is also responsible to provide subsequent follow-up about the case, including ultimate outcome, to the referring unit.

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