Because only 8 percent of hospitals have a pediatric intensive care unit, most critically injured children will need transportation to another facility. The first step is to assure that all identified injuries are treated to the best ability of the referring hospital and that the child is maximally stabilized. Few areas possess a dedicated pediatric critical care transport team to manage the patient during the transportation. The next best option is to have a critical care transport team with some pediatric experience (pediatric nurse or pediatrician) traveling with the child. Indications for pediatric critical care experience on the transport team are endotracheal intubation, potential airway compromise, spinal injury, hemodynamic instability, pressor infusions, skull fractures, pelvic fractures, or a child currently receiving blood products. Standard advanced life-support crews can be used for children without airway problems or hemodynamic instability. Increasingly, pediatric trauma centers have their own home-based interhospital transport systems and will arrange transportation from referring sites.
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