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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