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interventions, and preparation for transport to be accomplished before the team
arrives. Telemedicine can improve the pretransport assessment availability of
visual and auditory data and should offer a more individualized, higher level of
initial assessment and advice.
When the transport team arrives, after a concise medical handoff, they should
review the medical history, including all therapeutic maneuvers and interventions
performed at the referring hospital. Ideally this handoff is part of a standardized
process as described in 2013 by Weingart et al. An efficient and focused physical
examination is mandatory. During this pretransport process, endotracheal tubes,
chest tubes, IV and intra-arterial catheters, and other indwelling devices should be
checked for proper placement and stabilization. When doubt exists, devices
should be resecured or replaced.
After this initial assessment, the transport team, in concert with the medical
control physician, should decide if any, additional medical interventions are
required to be initiated and/or continued before leaving the referring center. Such
interventions are most appropriate when they may have a direct impact on patient
outcome. For example, the child who may have meningitis should receive
antibiotics before or during the transport process, but a lumbar puncture may be
deferred until arrival at the receiving hospital. The appropriateness of
interventions will, to some degree, be dictated by the distance to the receiving
hospital. For example, a child with a circumferential burn of an extremity may
require an escharotomy to minimize or prevent vascular compromise. If the
receiving hospital is 5 minutes away, this might be appropriately deferred.
However, if the receiving hospital is 2 hours away, it may be prudent to have the
procedure performed before departing from the referring center. Again,
transmission of images or materials to the receiving center or medical control
physicians can help in the patient management. This could include images of the
patient, computed tomography scans or x-rays, as well as copies of ECGs or other
assessments. Availability of point-of-care testing is helpful for continued patient
assessment during transport.
After the patient is optimally prepared for transport, he or she must then be

moved from the referral facility’s bed to the transport stretcher, and then to the
vehicle. Such movements represent great risk to the patient, so staff should
exercise extra vigilance during patient transfer. IV catheters and endotracheal
tubes are most likely to be displaced while the patient is being moved.
Consequently, patients should be subjected to the fewest transfers necessary to get
them from the referring hospital to the definitive bed/location they will occupy at
the receiving hospital. Personnel should be assigned to secure lines and tubes, and