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Regionalized intensive care is a concept that has gained wide acceptance in neonatology and pediatric care.1 This concept mandates that expensive, high-technology, labor-intensive therapies be limited to a few regional centers. Because patients in need of these services may initially present to other hospitals, interfacility transport has developed as a complement to regionalized intensive care.2 The referring hospital or, more commonly, the regional center, may assume the responsibility for transport of a patient to a regional center. Because community EMS systems often are not equipped to transport critically ill children, the interfacility transport of pediatric patients frequently is conducted by specialized transport services.2 Under these circumstances, the referring hospital and its medical care staff have important responsibilities related to transport; ED personnel often assume these responsibilities because the ED is the site of initial care.

Moving critically ill patients between hospitals invariably adds to the risks of the illness or injury because of the hazards associated with the transport environment, particularly during the transport of neonatal and pediatric patients.3 An understanding of the transport environment is important for individuals who participate in the preparation of a patient for transport, as well as for those who conduct the transport. The features of transport that distinguish this environment from the inpatient setting and the effects of these features on patients and caretakers are outlined in Table 4-1.

Table 4-1 Features of Transport versus Inpatient Setting and Effects


Suggested guidelines to minimize the impact of the handicaps inherent in a transport environment are:


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