Hawler medical university College of medicine

Department of surgery /pediatric surgery

Transport of sick child

Goal of transport team : providing high-quality intensive care throughout the

transfer process. effectively providing an intensive-care bed on the

move . improve the morbidity and mortality through the

receipt of expert critical care and specialist expertise, including surgery

Children who have been the victims of

trauma

Term and preterm neonates with either

major congenital anomalies or

complications

Infants and older children who have

either a severe form or a complication

Who needs transport?

• The makeup of a regional transport team has many influences, including local geographic factors such :

the distances needed to travel . the size of the area covered.presence of any difficult-to-access sites, such as islands or

remote mountainous sites .

Regional considerations

Transport team

Medical director Transport coordinator

Duty consultant

Transport doctor Transport nurse

Transport paramedic Transport driver/pilot

05/01/2023

What Quality require of individuals to perform critical-care transport ?

Clinical skills, including manual dexterity Diagnostic skills Good interpersonal skills Ability to cope with stress Good physical health Resistance to fatigue and motion sickness Enthusiasm and commitment

What are Equipment's which need in child transport??

Air way access Vascular access dressings

chest drains urinary catheters

Monitor Ventilator Defibrillator

Immobilization device Transportation device

transport vehicles

Road ambulance

advantage Ease of training Readily available Disadvantage Traffic Transport times longer

Rotary-wing aircraft

Advantage Easy access to difficult and remote location. Smoother flight. Disadvantage May require multiple patient transfers In event of crash, less survivable

05/01/2023

Fixed-wing aircraft

Advantage Rapid transport over distances Fly above or around bad weather Disadvantage Negative effects of high altitude if not pressurized Substantially higher costs

Factors to be considered when selectingmode of transport : Severity of patient’s illness Post-resuscitation stability Urgency for which specialist care is required Transit times between the hospitals involved Availability of vehicles Personnel’s abilities Weather and traffic conditions Geography Safety Cost

By : Pediatric assessment triangle(PAT): A-B-C

How to recognize & assess of the sick child ?

Primary assessment

Air way

Birthing

Circulation

DisabilityExposure

patency

Need simple management positioning head tilt-chin lift Use airway adjuncts ( oral

airway)

Require advanced intervention ET intubation cricothyroidotomy CPAP

Airway

Respiratory rate Respiratory effort Airway and lung sounds Pulse oximetry

Breathing

Evaluate cardiovascular function heart rate and rhythm Pulses capillary refill time blood pressure and pulse pressure

Evaluate end-organ function brain perfusion skin perfusion renal perfusion

Peripheral Pulses• Present/Absent• Strength

Skin Perfusion Capillary refill time Temperature Color Mottling

Systemic perfusion

CNS Perfusion Level of consciousness

Renal Perfusion Urine 1-2 cc/kg/hr

Secondary assessment Signs and Symptoms Allergies Medications Past medical history Last meal Events leading to presentation

RECORD-KEEPING, CUMENTATION

AND AUDIT All parties involved in critical-care transport should keep accurate notes of the referral, advice given and management throughout the transport. This enables accurate and meaningful audits to be performed and, hence, facilitates ongoing quality improvement of the service

SOCIAL ISSUES

OUTCOME

Specialist teams perform the majority of critical-care transports safely and effectively.• A clear understanding of individual roles and

responsibilities along with rapid and efficient communication

• help to ensure that patients receive the most appropriate care during transport before delivery of definitive surgical care

Thank you