Please retrieve this child!

PICU

Before calling your local retrieval team when you have a sick child, take a few moments to organise yourself:

Getting this right will make everything more straightforward for you, the rest of your team, the transport service, and most importantly the child.

Have you spoken to your consultant? Updated them on the situation? Asked for their advice? Are they coming in? It is essential to discuss a child with your consultant before calling a retrieval service, they are ultimately responsible for that child’s care and will be able to offer practical advice and support.

Do you have all the relevant information to hand? Demographics, background, latest observations, blood gases etc . It may help to have a look at the local retrieval services referral form, usually these are available online.

Be aware that while you are discussing the patient over the phone with the transport team, you won’t be directly at the bedside. Have a ‘timeout’ so that everyone is on the same page, then brief your team on what you want them to do in the meantime, so that interruptions to your conversation are at a minimum. If there are any complications that you expect, give them a strategy for what should be done in the first instance (i.e. ‘if the blood pressure drops below xx again, give another 10ml/kg fluid bolus then come and tell me‘)

Start off with a clear statement of intent – what do you want from the retrieval team? Then give the relevant information in a structured way. Using the ‘SBAR’ handover structure will make things clearer for the team (and less stressful for you). Remember to note down who you spoke to and their advice. If you are unclear what you should do next, clarify this now, with the retrieval team and your consultant.

 

Once the team are on their way, here’s a rundown of what you need to do in preparation.

 

  • Do not delay urgent interventions while awaiting the retrieval team e.g. – intubation, aggressive fluid resuscitation if required, consider inotropes (start peripherally if indicated), ICP management.

 

  • Good intravenous access is a priority. In paediatric patients at least 2 well secured and patent peripheral lines are necessary – consider IO if difficulty in obtaining access. Arterial and central access can be helpful, the anaesthetic team may be able to assist you with this. In neonatal transfers umbilical access should be obtained, though if this is difficult or delayed a peripheral access to give dextrose should be sited.

 

  • Prepare infusions and drugs ready for transfer, sedation, inotropes, fluid boluses in 50ml syringes. If your local retrieval service has a drug calculator use this (here’s the (London) CATS version).

 

  • Document your actions and prepare a summary, be concise but include as much relevant information as possible, include bloods gases, etc. – and don’t forget to electronically link images to the receiving hospital.

 

  • Keep parents as informed as possible, ensure they do not leave before the retrieval team arrives. Don’t promise that they can travel with their child until you have asked the retrieval team whether this is possible.

 

  • Hand over to the retrieval team, give them the documentation you have prepared, and do not immediately disappear! Make sure they have what they need, they will not be as familiar with your environment as you are and will not be able to do things such as order or view x-rays etc.

 

Then breathe a sigh of relief, make yourself a well-earned cup of tea (or beverage of your choice) and get back to the inevitable 4 hour wait in A&E while you were dealing with this.

Any sick / complicated patient (and those requiring transfer usually are) is a good learning case. Consider this a golden opportunity for WBPA, once you have had time to reflect. Ideally, debrief with your team – this can sometimes be difficult soon after the event, but it can be hard to gather the relevant people together on another occasion.

And finally, remember to thank your team for their hard work !

Dr Mark Butler, ST7

 

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