Transferring a child can be an intimidating prospect, but is an essential part of managing sick children,
particularly those who need critical care or specialist services. It may be a transfer from one hospital area to another, or may be an international journey, but some basic principles are the same. It is a complex and potentially risky process, but by thinking about the various steps involved systematically we can ensure that transfer is as smooth and safe as possible. One approach which is widely used and taught in APLS is ACCEPT. (and of course we all love an acronym).
Preparation and Packaging
Assessment: You may have already been involved in the care of this patient, or you may become involved for the purpose of transfer. It is always vital to start the process by gathering the relevant information and undertaking your own assessment, however it does not end there, assessment and reassessment should be an ongoing and dynamic process throughout transfer.
Control: A specific person should take control of the situation, this will vary by the particular context of your transfer, but there should be no uncertainty about the roles and responsibilities of those involved. Identify what needs doing, and who will do it.
Communication: You may need to communicate with a number of teams and personnel, you should have already identified who you need to talk to and who will be doing it. Do not forget the child’s parents or carers. It is vital that information is passed on clearly, a structured communication tool such as SBAR can be useful here. Try and consider before starting a conversation/ telephone call etc what you need to convey or what information you need to gather. It can be useful to recap or summarise at the end of conversations, with an emphasis on actions required and what will happen next.
Evaluation: Is transfer the appropriate action for this child? How urgent is it? Use an ABCDE approach to systematically assess the current status of the child and anticipate problems which could arise during transport.
Preparation and Packaging: Preparation involves ensuring you have adequate equipment, that it is working, and that you have the drugs, fluids and personnel you require. Most places will have preprepared ‘transport bags’ or equivalent, which include the basic equipment you need. Everywhere should have a “transport checklist”, if not they are widely available from transport services and a great quality improvement project to get one implemented locally. Think critically about what you need for your particular task, and ensure you familiarise yourself with your kit and how it’s organised, tipping everything out onto the bed is not an efficient method of locating what you need and is likely to waste more time. You need to think ‘a step ahead’ preparing fluid boluses, inotropes , drugs ready for sedation, intubation etc is time well spent. ‘Packaging’ is also vital, make sure all lines, equipment etc. are well secured.
Transportation: all of organisation and preparation should hopefully make this as smooth a process as possible. As far as practical, the standards of monitoring and of care in hospital should be continued in transit. Transport itself may cause physiological disturbance and deterioration, anticipate this and respond accordingly. Reassess frequently, using the ABC approach you would with any unwell child. Balance the risks and benefits of any intervention against the delay in arriving at your destination. Once you have arrived a clear and concise handover should be provided to the receiving team and supported with written documentation of the events of the transfer.
Transport of sick children is a skill that needs practice, you should always ensure you are acting within your own competencies and get senior help and support early. Most transport services run study days that help develop these skills and there are specific transport focused courses around the country:
Further information :
Check your APLS manual – Chapter 24
Most retrieval teams run study days regularly around their region, here are a few other courses focused on transport practitioners:
Paediatric and Infant Critical Care Transport Course (Leicester)
SPLAT (Simulated Paediatric Life Support and Transfer) Course (Bristol)
Paediatric and Neonatal Safe Transfer Course (PaNSTAR) /Neonatal, Adult and Paediatric Safe Transfer and Retrieval (NAPSTAR) (ALSG in Manchester)