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Every day many children around the world die because of lack of access to appropriate health facilities: lack of transport from their home to primary care settings, from primary care settings to district hospitals or from these smaller hospitals to tertiary referral centers where pediatric intensive care can be provided. The centralization of pediatric intensive care in developed countries has led to the development of specialized pediatric retrieval teams to undertake stabilization and safe transfer of critically ill children from referring hospitals to regional pediatric intensive care units. However, in a large country like India, the issue of safe transport for seriously ill children is more complex and is still in the early stages of its development. Many a times a critical patient is brought to the hospital by car, taxi or auto-rickshaw. Organization of transport processes will go a long way in improving intact survival as shown in many countries. Whether the child is being transported to a critical care facility or is on the unit, the principles of medical management will be the same. However, medical care during transport must take into account the risks inherent to moving and transferring the patient between institutions. This process of transport imposes an additional burden on hemodynamic balance of these delicate patients. Inspite of these constraints, Pediatric Critical Care Transport teams deliver high quality intensive care at an early stage in the patient’s condition, namely at the point of contact with health care professionals, rather than on admission to Pediatric Critical Care facilities. When we talk about transport of a critically ill child it could essentially mean an extension of pediatric intensive care, yet it’s a different ball game altogether. The chapter will focus on the logistics of transport medicine, which enables the whole process. Following a polio epidemic in Scandinavia, the first pediatric critical care unit was established in Sweden in the late 1950s. As the discipline became more established, provision of services became more structured, leading to a concentration of expertise and resources within regional lead centers. Furthermore, advances in critical care medicine has resulted in improved survival rates, particularly among premature infants and children with complex medical conditions. Consequently, the need to transport critically ill children to appropriate institutions has risen. The military have a long history of transporting the critically ill, initially on foot with stretcher- bearers moving wounded soldiers from the frontline. Aero medical transport of injured soldiers began in World War I and became a prominent feature of subsequent conflicts, particularly the Korean and Vietnam wars. The military followed a strategy of ‘scoop-and-run’, whereby the casualty was very quickly transported to hospital facilities with little pre-transport stabilization. Advances in critical care medicine has resulted in improved survival rates, particularly among premature infants and children with complex medical conditions. Consequently, the need to transport critically ill children to appropriate institutions had risen. Initially the attending team used to transfer patients to these institutions but it was soon realized that transport of these sick and unstable patients require expert services which could be provided by specialized pediatric retrieval teams. Subsequent studies indicated that morbidity and mortality of critically ill patients were much reduced if specially trained teams conducted transport and delivered life-sustaining treatments. The second consequence was the development of the ‘stay-and-play’ concept, where the patient received maximum stabilization at the referring hospital before transport. This highlights the limits and the potential destabilising influence of transport on the patient. Scene run - from a non-medical site to the nearest available or designated hospital. In this chapter we will be concentrating on inter-hospital transport of critically sick children though whether the child is being transported to critical care facilities from outside the hospital or within the same hospital the principles of medical management remains the same. There may be may various situations when transferring a critically ill child to another facility is considered. Such a situation may arise due to non availability of pediatric subspecialty ( neurology, nephrology) or specific investigation (e. Or it may be simply due to non availability of continuous monitoring in the referring hospital. The need for transport may also arise out of request from patients relatives due to variety of reasons. Once a patient who has been treated in tertiary hospital is stable, he might be needed to be transported back to the referring hospital for further on going care. The goals of an effective transport system should be: • To reach persons in need as quickly as possible with trained personnel • To stabilize the patient’s condition preventing further deterioration • To move the patient to a facility capable of providing more extensive care or additional services that will enhance patient outcome • To offer the level of care equal to the receiving institution recognizing the limits inherent in traveling. If ambulances are readily available, teams can use them to travel to the referring hospital as well as the to the receiving unit. However, they can be uncomfortable and may induce travel sickness, particularly over long journeys. For long journeys, urgent transports, and when ambulances are not available, rapid response vehicles may be preferable. On the return journey, if there is insufficient room in the ambulance to allow a parent to escort the patient and team, rapid response vehicles can also be used to transport the family to the receiving unit. Generally, decisions to transport by air will depend on a number of factors including severity of illness and distance involved. Adult studies have indicated that if travel is predicted to be above 80 kilometers or 90 minutes’ duration, then air transport is preferred. Other factors including availability of aircraft, crew, weather conditions, cost, and mobilization times will also influence the decision. It is also preferable to have knowledge of “charge structure”, mandatory deposit required prior to admission if any. The reason for transport, option of institute, and the financial implication should be discussed with them. The clinical condition of the patient should be thoroughly discussed with physician at the tertiary care centre and any advice about patient management sought. It is strongly recommended that critical care transport be performed by a minimum of two trained individuals. Team members should be trained and competent in pediatric critical care and transport medicine, be expected to provide advanced pediatric resuscitation and recognize limitations and physiologic effects of transport on the patient Inter-hospital transfer of critically ill children by specialist retrieval teams tend to be associated with a lower incidence of major complications than those transported by a non-trained personnel.
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Multimorbidity is the the bone is selectively impaired, most ofen because of defciency concurrent occurrence of several chronic disorders generally requir- of vitamin D.