What are the best practices for transporting a patient from an Emergency Department (ED) to a pediatric Emergency Department (ED) when the patient's condition is not critical but requires specialized care?

Best Practices for EMT Transport from General ED to Pediatric ED

When transporting a pediatric patient from a general emergency department to a specialized pediatric ED, prioritize pre-transport stabilization, establish physician-to-physician communication before departure, ensure continuous monitoring during transport, and prepare comprehensive documentation—avoiding the "scoop and run" approach that lacks evidence for safety. 1

Pre-Transport Communication Requirements

Before initiating any transfer, the referring ED physician must establish direct physician-to-physician contact with the receiving pediatric ED to confirm acceptance and resource availability 1. This communication should include:

• Complete description of the patient's current condition, vital signs, and interventions already performed 1
• Confirmation that the pediatric ED has appropriate resources available for the patient's specific needs 1
• Discussion of any additional stabilization measures needed before transport 1

A nurse-to-nurse report must also occur, either before departure or immediately upon arrival at the receiving facility 1. This dual communication pathway (physician-to-physician and nurse-to-nurse) ensures continuity of care and prevents critical information loss during handoff.

Patient Stabilization Before Transport

There is no evidence supporting a "scoop and run" approach for interhospital pediatric transfers 1. The referring ED must begin appropriate evaluation and stabilization before transport, though nonessential testing that delays transfer should be avoided 1.

Essential pre-transport stabilization includes:

• Secure intravenous access (peripheral or central if peripheral unavailable) 1
• Airway evaluation and securing if intervention likely needed en route (endotracheal intubation if indicated; laryngeal mask airways are NOT acceptable for critically ill patients during transport) 1
• Fluid resuscitation and inotropic support initiated if needed, with all IV fluids in plastic (not glass) containers 1
• Nasogastric tube placement for patients with ileus, obstruction, or requiring mechanical ventilation 1
• Foley catheter insertion for patients requiring strict fluid management or extended transport duration 1

For trauma patients specifically, spinal immobilization must be maintained unless significant spinal injury has been reliably excluded 1.

Monitoring Requirements During Transport

All pediatric patients undergoing interhospital transport must have minimum continuous monitoring including pulse oximetry, electrocardiographic monitoring, and regular blood pressure and respiratory rate measurements 1. This is non-negotiable regardless of perceived acuity.

For mechanically ventilated patients, endotracheal tube position must be noted, secured, and adequacy of oxygenation/ventilation reconfirmed before departure 1.

Selected patients based on clinical status may benefit from additional monitoring of intra-arterial blood pressure, central venous pressure, or capnography 1.

Essential Equipment and Medications

Your transport unit should carry comprehensive pediatric-specific equipment including 1:

• Airway equipment: Appropriately sized endotracheal tubes, laryngoscope blades, bag-valve-mask devices
• Monitoring equipment: ECG monitor/defibrillator with pediatric capabilities, pulse oximeter with pediatric sensors
• Vascular access supplies: IV catheters sizes 14- to 24-gauge, intraosseous access equipment
• Infusion pumps for precise medication delivery 1

Medication requirements include resuscitation drugs (epinephrine, atropine, adenosine, dextrose solutions), sedatives/analgesics, and specialized medications added immediately before transport as indicated (narcotic analgesics, sedatives, neuromuscular blocking agents) 1.

Documentation Requirements

A copy of the medical record including patient care summary and all relevant laboratory and radiographic studies must accompany the patient 1. However, preparation of records should not delay patient transport—these can be forwarded separately by fax or courier if urgency precludes their assemblage beforehand 1.

Critical information that must be immediately available includes current vital signs, medications administered, procedures performed, and ongoing treatment requirements 1.

Special Considerations for Pediatric Transfers

For time-critical pediatric conditions, specialized pediatric transport services generally provide better outcomes 1. However, for specific time-critical conditions (extradural hematoma, acute subdural hematoma with mass effect, obstructive hydrocephalus, acute ischemic stroke requiring thrombolysis), immediate transfer by the local team may be appropriate rather than waiting for specialized transport 1.

Pre-determined pathways should exist between referring hospitals and pediatric centers, with the regional transport service coordinating acceptance and triggering appropriate receiving hospital pathways 1.

The transport team should ideally include personnel with pediatric-specific training and experience, particularly for brain-injured or critically ill children 1.

Handover at Receiving Facility

Upon arrival, staff at the pediatric ED should be immediately available to receive a comprehensive "hands-off" handover 1. This means temporarily removing the transferring provider from hands-on patient care while describing the patient's history, examination findings, investigation results, and clinical course to the receiving team 1.

Medical notes and a copy of the transfer record should be left with receiving staff 1.

Common Pitfalls to Avoid

• Do not delay transfer for nonessential testing or imaging that won't change immediate management 1. Advanced imaging should only be obtained at the referring ED if it allows the patient to be discharged or remain there; otherwise, transfer first and image at the pediatric center where definitive care will occur 1
• Do not transport without securing the airway if intervention is likely needed en route—this is exponentially more difficult in a moving vehicle 1
• Do not use neuromuscular blocking agents without sedation and analgesia 1
• Do not assume non-urgent presentation means low acuity—parents often misjudge severity, with 63% of those triaged as nonurgent believing their child's condition was "very" or "extremely" urgent 2