Transport of the Pediatric Trauma Patient

Adam Cheng MD, FRCPC (Ped EM), FAAP

BACKGROUND

Critically ill children have better outcomes when treated in pediatric trauma centers and tertiary pediatric intensive care units.¹
Pediatric intensive care unit centralization has increased the need for interhospital pediatric transports.
Specialized pediatric retrieval teams have been developed in many countries to undertake the stabilization and safe transfer of critically ill children.
Pediatric trauma patients are best cared for in centers that are prepared to treat sustained injuries.¹

COMPOSITION OF PEDIATRIC TRANSPORT TEAMS

Team may include critical care paramedics, nurses, respiratory therapists, or physicians.
Recommend at least 2 patient care providers per transport, with 3 care providers for more critically ill children.²
Aim to match team members’ skills to patient needs.
Incidence of complications is decreased with dedicated, specialized transport teams.²

PREPARING FOR TRANSPORT: EQUIPMENT AND MODE OF TRANSPORT

Equipment

See Table 22-1 for list of equipment required to transport a critically ill child.
Optimally small, lightweight, and sturdy.
Regularly check and service all transport equipment.
Bring extra batteries/power source for all equipment.
Replenish used medications and supplies after each transport.

Mode of Transport

Determined by several factors:
- Urgency of case.
- Distance.
- Traffic conditions.
- Weather.
- Availability of air/land transport.
Equipment availability may vary by mode of transport.
- Check beforehand and bring additional supplies.
Voltage capacity in different settings may vary. Having additional battery packs may be useful but cumbersome.
See Table 22-2 for Selected Modes of Transport.

TABLE 22-1 Equipment Required When Transporting a Critically Ill Child

Monitors	Heart rate/rhythm Blood pressure Pulse oximetry End-tidal CO₂ Temperature Blood glucose Extra batteries
Infusion Pumps	Multiple infusion pumps Pressure infuser Extra extension tubing, stopcocks, T-connectors Various IV fluids Extra batteries
Resuscitation Equipment	Airway equipment Suction equipment Central lines Chest tubes Intravenous and intraosseous needles Proper-sized resuscitation board/stretcher
Drugs and Fluids	Resuscitation drugs Infusion drugs Sedative/paralytic drugs Antibiotics Intravenous fluids/blood if necessary
Portable Oxygen Supply	Oxygen: Ensure adequate amount for transport
Ventilator	Appropriate ventilator for desired mode Appropriately sized circuit (neonate vs. child vs. adult)
Document Folder	Patient chart Transport record Information for parents Telephone numbers
Clothing	Personal protective clothing: Gowns, gloves, and masks Warm clothes Change of clothes (for long transports) Appropriate footwear
Communication	Portable phone Extra batteries
Personal Care	Food and beverage for longer transports Personal hygiene items for potential overnight transports

PREPARING FOR TRANSPORT: PRIOR TO LEAVING THE SENDING FACILITY

General Principles

Do no harm:¹
- Avoid undue delay.
  - Especially if patient requires specialized tertiary care.
- Ensure safety of transport.
Timely, optimization of patient condition prior to transport.
Aim to provide care equivalent to sending hospital’s capabilities.
Follow an organized, structured approach to assessing patient.
Ensure patient has received a full primary and secondary survey.
- See Chapter 2 on Primary and Secondary Survey for details.
Communicate with receiving hospital prior to departure.
Anticipate patient care needs during transport.

TABLE 22-2 Selected Modes of Transport³

Road/Land Ambulance	Advantages
		Rapid mobilization
		Large working area
		Ability to stop for procedures
	Disadvantages
		Slow transit time
		Bumpy ride, motion sickness
Helicopter/Rotor-Wing	Advantages
		Rapid mobilization if service available
		Fast
		Can land directly at facility/scene
	Disadvantages
		Limited work area
		Noisy
		Vibration with turbulence
		Operation limited by weather
		Pressure considerations
Fixed-Wing Aircraft	Advantages
		Long distances traveled in short times
	Disadvantages
		Noisy
		Vibration with turbulence
		Operation limited by weather
		Requires additional legs of patient transport (to/from airport or hospital)
		Pressure considerations