Safe transport for critically ill and injured children

Critically ill or injured children often develop their problems far from where they need to be in order to get the care they need. A common scenario is for a child to be brought initially to a facility such as a general community hospital, where they are stabilized and receive initial therapy. Following this, however, they often need transport to a larger facility with specialized resources, such as a children’s hospital. To get there they need to ride in an ambulance, an airplane, or a helicopter. Are there risks to that? Unfortunately, although the risks are small, they are real, as you can read about here. As with everything we do in medicine, the risks of the transport needs to be weighed against the benefit of getting the child to facility that can better care for the child.

How common are accidents with pediatric transports? The last data I saw are from 2002, in which a survey of all pediatric transport teams in the United States asked if they had suffered any accidents in the preceding five years — 42% of the teams answering the survey had. These included 9 aircraft crashes and 57 ambulance accidents. To judge transport risk, of course, we need to know a key piece of information — the total number of transports — and this number is unknown. We do know that there were about 150 pediatric transport teams in the country at the time, and a typical team does around 100-200 transports each year. That’s a pretty broad range, but it would estimate the accident risk to be somewhere around 0.05-0.1%. This isn’t a big number, but 5 to 10 mishaps of some kind for every 1,000 trips does indicate a real risk. Many of the ambulance accidents were minor, but, as you can read in the link above, some of the air transport accidents were not. Overall, there were 8 deaths and 10 serious injuries to patients or transport personnel during the 5 year period.

Fifteen years ago I founded and subsequently ran for nearly a decade a pediatric transport program, during which time I made quite a few flights in both fixed-wing aircraft and in helicopters. I quickly learned how difficult that work environment can be for the medical team. Our team suffered one accident, the result of engine malfunction with our helicopter; fortunately, no one was injured, but the incident underscored for all of us the risks of the process. (I don’t do that any more, but I continue to be a member of the Transport Section of the American Academy of Pediatrics.)

From a patient-care perspective, the main advantage of helicopter transport versus ground ambulance is speed (fixed-wing aircraft transports are a bit separate, being typically used for long-range transports over hundreds of miles). Speed is especially important for severe trauma cases. The principal disadvantage of a helicopter, compared to an ambulance, is that the former is a very difficult environment in which to work; it is noisy, cramped, and often buffeted about in the air.

In spite of the risks of transport, specially-trained pediatric transport teams are an important component of all regionalized pediatric critical care systems. If your child’s doctor recommends this for your child, the slight risk of the trip is far outweighed by the benefits of getting your child to the people best equipped to care for her. Do ask about the members of the transport team — if they are specially trained to do pediatric transports and, overall, give the best results.