PhD FRCP FRCPCH,
Senior Lecturer. Imperial College, London *
|There is now substantial data to fuel the debate on the merits of regionalization of Paediatric Intensive Care [PIC] (1). Most critically ill children presented to their local hospital will therefore need to be transported to the nearest appropriate PIC unit. The basic elements include personnel, equipment, communication and transport. Appropriately equipped, specialized transport teams provide the optimal standard for transport which leads to lower mortality and morbidity (2).
The ethos of 'mobile intensive care' best encapsulates the process involved. To utilize the response time appropriately, early communication with regional PICU will start the process with appropriate step-up management advice. Initial stabilization and resuscitation will remain the responsibility of the local team. The fear that the specialized teams will deskill the local hospital staff has not been substantiated (3).
Experience of setting up retrieval services in London and the South East of England and evolution into a full regional transport service will be discussed.
The application of the model to areas with limited resources needs further consideration. In developing countries the cost-benefit of a specialized pediatric retrieval team [SPRT] needs to be balanced against very compelling and competing primary healthcare priorities. Other measures to reduce adverse events during inter-hospital transfers, such as training of transport staff, provision of suitably equipped transport vehicles and close liaison with the tertiary PICU (before and during transport) might offer a viable alternative to a SPRT in a resource-limited setting.
- Pearson G, Shann F, Barry P, et al: Should pediatric intensive care be Centralized? Trent versus. Victoria. Lancet 1997;26;349:1213-1217.
- Britto J. Nadel S, Maconochie I, Levin M, Habibi P. Morbidity and severity of illness during interhospital transfer: impact of a specialized pediatric retrieval team. BMJ 1995 Sep 30;311(7009):836-9.
- Ramnarayan P. Britto J. Tanna A, Thomas D, Alexander S, Habibi P. Does the use of a specialized pediatric retrieval service result in the loss of vital stabilization skills among referring hospital staff? Arch Dis Child. 2003 Oct;88(10):851-4.
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|Habibi P.. Available From : http://www.pediatriconcall.com/fordoctor/ Conference_abstracts/report.aspx?reportid=303|