Transfer Guidelines
This section is written by the All Wales Paediatric Critical care Network. If you have any feedback to offer, use the contact link above, and it will be passed on to the group.
Most critically ill children (Levels 2 or 3) are currently moved between hospitals by the Paediatric Intensive Care Retrieval Team. However there are some patient subgroups that will continue to be transferred by the referring hospital:
- Burns patients (pending the final outcome of the Burns review)
- Closed head injury patients/acute hydrocephalus
- In the rare event of a retrieval team being unavailable
- Children requiring level one care in a tertiary centre due to their requirement for tertiary specialist involvement.
Critically ill children are at increased risk of morbidity and mortality when being transferred. The decision to move or transfer any child must be made by the consultant responsible for the child's care in full liaison with the appropriate staff at the child’s intended destination and the child's family.
The transfer must embody clear, clinical advantages for the child and be balanced against the potential risks inherent during any transfer.
Children require not only resuscitation but comprehensive stabilisation prior to their transfer whether this is to scan (intra hospital) or to another trust (inter hospital). The centre that you are planning to move the child to should be informed as early as possible and advice sort.
Click on the panels below for specific advice - clik the panel header again to close it.
Safety must be paramount once the decision is made to transfer a child
- The staff accompanying the child should have the necessary skills to maintain stability and treat any changes in the child's condition during its transportation.
- They must be familiar with the equipment they are expected to use.
- The child must be secure for the duration of the journey harnessed or seat belted onto the trolley. No children should be transferred sitting with/on parents. Car seats should not be used in ambulances to transfer critically ill children and should never be attached to the Ferno trolley or equivalent for transfer.
All parents and staff must wear a seatbelt for the duration of the journey.
- The use of blue lights should be discussed by the team and only used if absolutely necessary as the use of them can increase the risk to the entire team and patient.
The local team are responsible for deciding what transport is deemed necessary for transfer of each case. Teams must be made aware of the implications if team members are not covered by adequate insurance. Air transport should only be used in exceptional circumstances.
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Airway & Breathing |
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Monitoring (adequate battery life) |
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Anaesthetic drugs are decided upon by the anaesthetist transferring the child
Drugs required for each transfer will depend on the clinical condition of the child.
This is a list of recommended drugs that should be considered prior to departure with any critically ill child.
A drug calculator can be found here to assist you in checking paediatric drug dosages.
Adrenaline 1in 10 000
Atropine 1mg in 5mls
Calcium Chloride10% in 10mls
Diazepam rectal tubes 5mg
Lorazepam 4mg in 1ml
Glucose 10%
Naloxone 400mcg in 1ml
Sodium Bicarbonate 8.4 %( 1mmol in 1ml)
Mannitol may need to be considered in neurosurgical emergencies.
Further anticonvulsants may be required if you have already administered Lorazepam.
Ensure that you have enough infusion fluids for the duration of your journey.
Airway replacement kit to hand |
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NG/OG Tube in situ |
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Notes Photocopied (scans packed if appropriate) |
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Is paperwork completed? |
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Baseline obs. Documented |
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Patient/Equipment secured |
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Airway secured |
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Alarms activated |
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ET tube patent(suction before leaving if required) |
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Parents updated/contact number |
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ABG Checked on Transport Vent |
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Information booklet given |
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Adequate sedation & paralysis |
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Referral centre telephoned |
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Chest X-Ray checked |
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Rucksacks x 2 |
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BM Stix checked |
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Drug Bag x 1 |
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IV Access x 2 secure and patent |
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Istat |
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- Parents should be advised not to leave their child until the transfer team is ready to leave.
- Parents should be told not to lead or follow the ambulance especially if a blue light journey is essential.
- The team need to ensure that the family have means of transport to the receiving hospital
- Decisions whether it is beneficial to the child for the parent to accompany them should be made locally.
- Parents need to be informed about the contact details and whereabouts of the clinical area that their child is going to.
- Parents need to be kept informed of decisions being made regarding their child's transfer.
- For further information regarding retrieval, the PIC unit, siblings, parent's leaflets can be obtained from the links at the top of the page