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particular patient. Holt et al. recently found that the PedCTAS, TPEWS, and
TRAP scores are all strongly predictive of higher acuity during transport and the
need for PICU admission at the receiving facility.
The medical capabilities of the transport system are important to assess and
plan. All transport teams do not have equivalent levels of pediatric skills.
Transport services can vary from specialized pediatric teams, such as those
supplied by tertiary care pediatric hospitals, to generalized transport services that
transport both adults and children. In addition, some teams have additional
specialized capabilities, such as the ability to initiate or transport patients
requiring ECMO, inhaled nitric oxide, and high-frequency ventilation or
oscillation. Unfortunately, there are no universal standards or regulations
regarding the level of experience or expertise in pediatrics required to transport
pediatric patients. There are, however, accrediting agencies and standards that can
be reviewed. The most specific transport accreditation process for transport
systems is through the Commission on Accreditation of Medical Transport
Systems (CAMTS). Although this is often a voluntary appraisal of a system,
certification is mandatory for licensing of some services in specific states. All
hospital-based teams should, however, comply with Joint Commission on
Accreditation of Healthcare Organizations requirements for patient care and
safety. Further, the National Patient Safety Goals, first established in 2003 and
updated most recently in 2019, mandates to improve patient safety through
correct patient identification, improved communication, medication safety,
healthcare-associated infections; transport teams are not exempt from
compliance.
Although different types of transport systems can efficiently and safely
transport pediatric patients, the referring physician is responsible for assessing the
selected transport system for medical sophistication and safety. As pediatric
diseases and processes differ from those in adults, one should not assume a
general transport service has adequate experience in pediatrics to offer the
appropriate or optimal level of care. In some cases, expedient patient transport by
a general team may be perfectly acceptable. For example, the stable trauma

patient, the child with a clearly defined medical process, or the patient needing
referral for a stable, non–life-threatening issue, may be adequately transported by
a transport team without extensive pediatric experience. Alternatively, however,
when the differential diagnosis needs to be explored during the transport process,
or when the patient’s condition is rapidly changing, an experienced pediatric team
with critical care skills is usually preferred. This process may be classified as
bringing pediatric care to the patient, as opposed to getting the patient to pediatric