pediatric essential care

1. Transfer of a sick child

2. Objectives
• Learn about steps to prepare a sick child for transfer
• Learn the equipment needed to prepare for transfer of a sick child
• Learn about documentation (form) for transfer of a sick child

3. The right patient is taken at the right time,
by
the right people, to the right place
by
the right form of transport and receives the right care
throughout’.

4. Places where stabilization of an ill child may take place
• The emergency department (ED)
• Children may also deteriorate during their hospital
admission in general ward

5. How to Transfer?
• A—Assessment
• C—Control
• C—Communication
• E—Evaluation
• P—Preparation, packaging, and pre-departure checks
• T—Transport

6. A=Assessment
• The standardized approach to the assessment & documentation
of it
• The structured ABCD approach to minimize errors and prevent
missed diagnoses
• Explore underlying diseases or ongoing diseases.
• Decide who will be transferring the patient (transfer team)
• Decide on accompanying guardian

7. C=Control
• Leadership during the stabilization and transfer is vital to ensure
safety and efficiency
• Initially leader may be the Duty Doctor in Emergency department
who may hand over care to the Senior most doctor/pediatrician
who can lead further
• A control in the chaotic ER is very difficult to achieve, thus a clear
role & action of a leader will decrease the mishaps

8. C=Communication
• The transport involves multiple individuals and poor communication is a
frequent reason for poor quality of work.
• Structured communication SBAR, for example:
• Situation = an 4 year old unconscious male child came in ER
• Background = he has history of seizure
• Assessment= vitals stable, but GCS 6/15, no obvious trauma sign, systemic
examination: normal other than CNS: pin point pupil. Child might be in post ictal stage
• Recommendation: I am coming, please Secure airway, recovery position, low flow
oxygen, IV cannula (send RBS, CBC, blood CS), IV maintenance/NPO, Pediatric
Neurology evaluation.

9. • Communication with parents and relatives are very essential,
throughout the stabilization & transfer
E=Evaluation
• Evaluate the case for suitability and need of transfer:
 sometimes even sick case gets better after stabilization so need
of transfer is to be made by the senior team members
• Practical decisions must be made about how the transfer will
take place, including the mode of transport

10. P=Preparation, packaging & pre-departure checks
• Confirm the availability of appropriate equipment
• Prepare documents for travel and handover documents
• Transport trolleys with weight-specific harnesses or transport
incubator can be used.
• Preparing well labelled infusions (IV, Inotropes, ongoing
medication etc.) and proper handover should be given
• Quick pre-departure check of all necessary things.

11. T=Transport
• Transfer is “period of mobile intensive care”
• Ideally, transport vehicle, should have all the advance life support
facility.
• Transport should be as smooth as possible:
Moderate speed
Reduced use of lights and sirens to reduce stress
Parents should be briefed about the transfer process and any safety
procedures

12. T=Transport (Continued)
• Prior contact to tertiary center with a clinical update and an
estimated time of arrival
• If patient has crashed during transport, receiving end should be
informed

13. What are the Equipment Requirement During
Transfer?

14. Equipment during transfer
• Drugs:
o Emergency drugs (adrenaline, atropine etc.), IV fluids, bolus of NS/ Dextrose,
IV antibiotics, Anti Epileptic Drugs, salbutamol for nebulization
• Equipment:
1. Infusion pump/ syringe pump or burro-set with micro drop
2. Basic life support equipment like bag & mask, oxygen, oxygen pipe etc
3. Monitor or pulse oximeter
4. Nebulizer
5. Trolley with harnesses
6. Blanket

15. प्रेसन फारम
नाम उमेर ल िंग
ठे गाना
आमाको नाम बुबाको नाम
टेल फोन नम्बर
प्रेसन गने अस्पता प्रेसन गने स्वास्थ्यकमी
प्रेसन गरेको लमलत/समय
प्रेसन हुने अस्पता सम्पक
क गररएको स्वास्थ्यकमी
प्रेसन गररएको कारण
लबरामी ाई रहेको अन्य समस्या :
 Kidney disease
 मधुमेह
 CNS disorder
 COVID-19

Vital signs: T:________◦F RR____/min HR_____BPM SpO2:______%
CRT_____ Sec BP__________mmHg
लबरामीमा देखिएको समस्याको सारािंस
 ---
 ---
 ---
लबरामी ाई गररएको उपचारको सारािंस
 ---
 ---
 ---
यात्रा क्रममा जारी रहने उपचारहरु:
 ---
 ---
 --
लबरामी ाई प्रेसनको ालग प्रयोग गररएको बाहन:
लबरामी सिंग यात्रा गने अलििावक:

16. Role play
• Group A : Referring team: 3 members
• Group B: Transfer Team : 2 members
• Group C: Receiving team: 3 members
• Group D: Audience: observe using Checklist
For the case and make the action plan for
Documentation /transfer/receive the case.

17. Case A: Suraj
3 year old male child from Gulmi, came to your District hospital, with
chief complaints of
• rapid breathing,
• fever and
• agitation
When child reached your hospital, child was conscious but was irritable,
Temperature 101F, RR 50/min, Pulse rate 130 bpm, SpO2 without O2 82%/
with O2 95%, on auscultation chest has Bilateral diffuse wheezes, mild
intercostal indrawing, CVS & abdomen examination normal. Suraj is 12 kg
Duty doctor, stabilized the case, but due to unavailability of bed patient is to
be transferred to Lumbini Provincial Hospital

18. Status of Suraj during transfer and on arrival
During transfer:
• Temperature: 102F
• Heart rate: 135bpm
• Respiratory rate: 55/min
• Spo2: 94% with oxygen via face mask
• Other physical examination is
unchanged
• Treatment given: PCM suppository
125mg PR stat dose
At arrival at Receiving end (ER):
• Temperature: 99F
• Heart rate:100bpm
• Respiratory rate: 45/min
• Sp02: 95%with oxygen via face mask
• Other physical examination is
unchanged.
• Treatment given at ER: Assessment/
communication and transfer to PICU

19. Summary
What is your feedback on the role play?
Use “ACCEPT” Method of Transfer for feedback.

20. Thank You!