Pediatric transport involves stabilizing critically ill children and continuing critical care therapies en route. The transport team conducts a thorough assessment using standardized approaches like the pediatric assessment triangle and ABCDE model. Key priorities are stabilizing the airway, breathing, circulation, neurological status and managing pain and anxiety. Important equipment includes ventilators, infusion pumps, suction, monitoring and temperature regulation devices designed for portability and reliability during transport. Proper preparation is essential to minimize risks and continue care seamlessly between facilities.

1. Pediatric Transport
Darin Aranwutikul, MD.

2. Goal
Early stabilization and initiation of advanced care
at the referring institution, with continuation of
critical care therapies and monitoring en route.

3. Recognition & assessment of
the sick child
Pediatric assessment triangle(PAT): A-B-C

4. Appearance :
TICLS Mnemonic
Tone Refers to child’s muscle tone
Interactivity Refers to degree of interaction the child has with his/her
environment or those attempting to interact with the child
Consolability Refers to the child’s response to parents or caregivers
Look /gaze Identifies whether the child tracks things appropriately
with his/her eyes or has a nonfocused gaze.
Speech/cry Refers to how the child vocalizes

5. Primary assessment
A B
• Airway
• Breathing
• Circulation E C
• Disability
• Exposure D

6. Airway
• Patency
• Need simple management
 positioning
 head tilt-chin lift
 Use airway adjuncts ( oral airway)
• Require advanced intervention
 ET intubation
 cricothyroidotomy
 CPAP

7. Breathing
• Respiratory rate
• Respiratory effort
• Airway and lung sounds
• Pulse oximetry

8. Normal respiratory rates
by age
Age Breaths per minutes
Infant (<1 year) 30 to 60
Todler( 1-3 yrs) 24 to 40
Preschooler ( 4-5 yrs) 22 to 34
School age ( 6-12 yrs) 18 to 30
Adolescent ( 13-18 yrs) 12 to 16

9. Respiratory rate
• Apnea
• Tachypnea
• Bradypnea
Bradypnea or irregular respiratory rate in an
accutely ill infant or child often signals impending arrest

11. Abnormal lung and airway sounds
• Stridor upper airway obstruction
• Wheezinglower airway obstruction
• Grunting lung tissue disease
• Crackles  lung tissue disease

12. Pulse oximetry
• Above 94% in room air
• Additional intervention is required if O2 sat<90%
in child receiving 100% oxygen .
• Be careful to interpret pulse oximetry in
conjunction with clinical assessment and other
signs.

13. Circulation
• Evaluate cardiovascular • Evaluate end-organ
function function
 heart rate and rhythm  brain perfusion
 pulses  skin perfusion
 capillary refill time  renal perfusion
 blood pressure and pulse
pressure

14. Normal heart rates in children
Age Awake rate Mean Sleep rate
NB to 3 mo 85-205 140 80-160
3 mo to 2 y 100-190 130 75-160
2 y to 10 y 60-140 80 60-90
>10 y 60-100 75 50-90
Typical physiologic response to a fall in cardiac output is tachycardia.

15. Blood pressure
Definition of hypotension
Age Systolic BP (mmHg)
Term neonates <60
Infants <70
Children 1-10 yr
5th BP percentile <70 + (age in years x 2)
Children > 10 yr <90

16. Systemic perfusion
• Peripheral Pulses
– Present/Absent
– Strength
• Skin Perfusion
– Capillary refill time
– Temperature
– Color
– Mottling

17. Systemic perfusion
• CNS Perfusion
– Level of
consciousness
• Renal Perfusion
– Urine 1-2 cc/kg/hr

18. Disability
• Establish the child's level of consciousness
• Standard evaluations are
 AVPU pediatric response scale
 Glasgow Coma Scale (GCS)
 pupillary responses

19. AVPU pediatric response scale

20. Glasgow Coma Scale(GCS)
-

21. Pupillary response

22. Exposure
• Remove clothing as necessary
• Palpate the extremities to assess for injury
• Measure core temperature
• Keep the child warm
• Use spine precautions when suspect spine
injury

23. Life threatening condition
Airway • Complete /severe airway obstruction
Breathing • Apnea,significant work of breathing,
bradypnea
Circulation • Absence pulses, poor perfusion,
hypotension, bradycardia
Disability • Unresponsiveness, depressed
conscious
• Hypothermia, significant bleeding,
Exposure purpura with septic shock, acute
abdomen

24. Secondary assessment
• Signs and Symptoms
• Allergies
• Medications
• Past medical history
• Last meal
• Events leading to presentation

25. Pediatric assessment flow chart
General assessment
PAT
If any time during the
Primary assessment assessment
A-B-C-D-E and categorization process
You identify a
Secondary assessment : life-threatening condition
SAMPLE
Tertiary assessment
Immediately initiate
Respiratory Circulatory life-saving interventions
and
activate the
Respiratory distress Compensated shock
Respiratory Failure Hypotensive shock
emergency response system
Respiratory +circulatory

26. Breathing is everything to a child
• The common denominator for unexpected deaths
in children is hypoxia.
• Do not increase the child's level of anxiety

27. Not only the child
• Needs of parents or caregivers must
be addressed.
• Be calm and confident.
• Written information and involve them
in plan of care.

28. Children don’t have less pain than adult

29. Numeric and FACES scale

30. FLACC scale

31. Drugs Dose (mg/kg) Route comments
Analgesics
Morphine 0.1-0.2 ;infusion 20-50 mcg/kg/hr IV Histamine
release
Fentanyl 1-2 mcg/kg;infusion 2-5 mcg/kg/hr IV,IO Chest wall
rigidity
Sedatives
Diphenhydramine 0.1 IV,PO
Ketamine 1-2 IV,IO,IM Increased ICP
lorazepam 0.1-0.2 IV,IO,IM Hypotension
Midazolam 0.1-0.2 IV Hypotension
Propofol 1-3; infusion 1-3 mg/kg/hr IV Hypotension
Pentobarbital 2-4 IV Apnea

32. YOU CANNOT REMEMBER
NORMAL WEIGHTS, RESPIRATORY
RATES, BLOOD PRESSURES, HEART
RATES, AND CALCULATE DRUG DOSES
IN YOUR HEAD SO DON'T TRY

33. Broselow tape

34. HOW TO STABILIZE THE CHILD

35. Stabilization of the respiratory
system
• Well oxygenated and ventilating prior to transfer
• Consider the need for intubation and mechanical
ventilation.
• Confirm ETT placement and secure the tube.
• Obtain blood gases while ventilating on the transport
ventilator before leaving
• Consider the need for sedation and paralysis

36. Stabilization of the
cardiovascular system
• Hemodynamically stable before departure.
• Treat compensated shock before departure.
• Invasive arterial blood pressure monitoring in
patients with inotropic support.
• At least 2 good, working points of IV access.
• Ensure availability of emergency or special drugs

37. Medications to Maintain Cardiac Output and for
Postresuscitation Stabilization
Medication Dose Range Comment
0.75–1 mg/kg IV/IO over 5
Inamrinone minutes; may repeat × 2
Inodilator
then 5-10 mcg/kg/min
Dobutamine 2–20 mcg/kg/min IV/IO
Inotrope; vasodilator
2–20 mcg/kg/min IV/IO Inotrope; chronotrope; renal and
Dopamine
splanchnic vasodilator in low doses;
pressor in high doses
Epinephrine 0.1–1 mcg/kg/min IV/IO Inotrope; chronotrope; vasodilator in
low doses; pressor in higher doses
Loading dose: 50 mcg/kg IV/IO
Milrinone over 10–60 min Inodilator
then 0.25-0.75 mcg/kg/min
Norepinephrine 0.1–2 mcg/kg/min Vasopressor
Sodium Initial: 0.5–1 mcg/kg/min; titrate Vasodilator
to effect up to 8 mcg/kg/min
nitroprusside Prepare only in D5W

38. Stabilization of the central nervous
system
• Minimize secondary brain injury due to
hypotension and hypoxia
• Appropriate treatment of prolonged seizures
• Adequate sedation

39. Stabilization of the gastrointestinal
system
• Placement of a nasogastric tube and left
on free drainage.
• Stop feeding and aspirate the stomach
before transfer.

40. Stabilization of the renal system
• Consider urethral catheterisation in
children
– with shock
– who are paralysed and sedated
– who have received diuretics or mannitol

41. Transport team assessment and
initial stabilization
• Rapid assessment
• Urgent therapy and manage life-threatening
conditions is priority
• Have patient as stable as possible before
loading into the transport vehicle.

42. EQUIPMENT USED IN PEDIATRIC
TRANSPORT

43. General features of all
equipment
• Self-contained, lightweight and portable
• Durable and robust
• Long battery life and short recharge time
• Clear displays
• Suitable for all ages
• Visible and audible alarms
• Data storage and download capability
• Secure

44. Batteries
• Use external sources of power when
available.
• Choose equipment that is not solely
reliant on internal rechargeable batteries.
• Do not rely on leaving them charging all
the time.

45. Trolleys

46. Ventilators

47. Humidification
Heat and moisture exchangers (HMEs):

48. Temperature maintenance

49. Infusion pumps
• Able to deliver flow rates from 0.1 cc/hr
• Able to bolus dose
• Should be light, compact and robust
• Easy to use
• Have alarms
• Long battery life

50. Suction equipment
• Portable suction units with battery power
• Foot pump suction units

51. Defibrillators
• Portable defibrillator or AED

52. Monitoring

53. Others

54. Reference
• American Academy of Pediatrics. Guidelines for Air and Ground
Transport of neonatal and pediatric patients, 3rd edition.
• David G. Jaimovich . Handbook of Pediatric and Neonatal
transport medicine, 2nd edition.
• Peter Barry.Paediatric and Neonatal critical care transport, BMJ
2003
• American Academy of Pediatrics. Pediatric Advanced life Support
provider manual 2006