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Child Health Guideline Identifier

Transport of an infant, child or young person

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Introduction

This guideline covers the transport of an infant, child or young person:

  • between Starship Child Health and another hospital; or
  • being discharged back to home region from Starship Child Health.

Where the transport involves the Starship Child Health NICU and PICU designated transport teams please refer to service specific transport guidelines.

This guideline does not specifically detail the process for the transport of children from home to Starship Child Health for elective admission. However, the patient transport requirements and need for clear communication between relevant healthcare teams to ensure the safety of the child during transport still apply.

These Transport Guidelines are consistent with and complimentary to the Paediatric Society of New Zealand position on "Child Passenger Safety 2012" and the Paediatric Society of New Zealand Position Statement on Standards of Practice for Inter-hospital Transport of Children; July 2015. 

Guiding Principles

A child's response to illness and injury differs both physically and psychologically from that of an adult patient. Children have needs that are very specific to childhood and they cannot be viewed in isolation from their family. These special needs must be provided for during every step of health care delivery including during transport. The need for acute hospital admission and / or transport is often a time of crisis for families.

Transport increases the risk of adverse and unanticipated events and should be minimised wherever possible.

A similar or increased level of care to that provided prior to transport should be maintained during transport.

Transport personnel should have the relevant expertise that matches the care needs of the patient; including neonatal, paediatric and transport knowledge, experience and clinical skills.

Prior to transport, the clinical team currently responsible for patient care will assess the infant, child or young person's clinical condition for suitability to transport, and determine the specific transport requirements.

Planning a child's transport is undertaken with due diligence and timeliness. Financial consideration is necessary but is secondary to patient clinical safety.

Transport arrangements should allow for an accompanying parent/caregiver wherever possible to reduce the child's anxiety and enable ongoing advocacy and communication. There may be times, however, when this is not possible due to parental illness/injury, size limitations of transporting vehicles or safety concerns.

An infant, child or young person less than 16 years of age, who does not have a parent / caregiver present during the transport, requires a healthcare staff member to accompany them.

An infant, child or young person who is assessed as physiologically stable with no safety concerns and no requirement for nursing intervention (e.g. intravenous fluids in progress, continuous nasogastric fluid in progress, oxygen therapy) or nursing surveillance during the transport, can be transported in the sole care of parents / caregiver as long as guidance is provided.

Informed consent is often indicated when transporting children:

  • Ensure parents / caregivers understand and agree why and how their child is to be transported. 
  • Where parents / caregivers are the sole accompanying adults ensure they understand what to do in the event of an emergency.

Children travelling in vehicles should always be transported in correctly fitted, age and size appropriate restraints, which comply with New Zealand Transport Agency's accepted standards and are secured into the vehicle according to the manufacturer's instructions.

There are a few situations where a child is not legally required to be seated in an approved child restraint. In exceptional circumstances a medical practitioner may provide a certificate to provide exemption from the use of a child restraint for a specified period of time. However Starship Child Health recommends that every effort be made to ensure that infants, children and young people are securely restrained in any moving vehicle whether it is the family's private vehicle, an ambulance or other service vehicles. For further information see http://www.nzta.govt.nz/resources/factsheets/07/exceptions-to-the-law.html

Patient Transport Recommendations

Click to bring up a downloadable/printable version of the Patient Transport Recommendation table here.

Important Telephone Numbers

Starship Child Health clinical services
Contact ADHB operator on 09 307 2800 and ask for consultant on call for specialty.

Paediatric Intensive Care Unit (PICU)
• Contact ADHB operator on 09 307 2800 and ask for on-call PICU Intensivist
• PICU front desk on 09 307 4903
• PICU registrar on 021 893 885
For further information about PICU transport and retrieval services see: http://www.adhb.govt.nz/picu/transport.htm 

Neonatal Intensive Care Unit (NICU)
• Contact ADHB operator on 09 307 2800 and ask for on-call Neonatologist
• NICU front desk on 09 307 2804
• NICU Clinical Charge Nurse on 021 874 779
For further information about NICU transport and retrieval services see: http://www.adhb.govt.nz/newborn/Guidelines/Admission/NeonatalTransport.htm

Children's Emergency Department (CED)
• CED front desk 09 307 4902

Skyline Aviation
• 0800 111 400

Hospital to Hospital acute transfer to Starship Child Health

Before a child is transported to Starship Child Health from another healthcare facility, responsibility for the transport process and arrangements for the handover of the child's care must be confirmed between all parties.  Accountability for clinical care is an integral part of transport, and remains with the referring team until such time as the child arrives at the destination unit, or until a transport team accepts accountability for clinical care in transit.

[*Where a child is coming for an elective admission to Starship Child Health from home, the responsible Starship clinician needs to have clinical cognizance of the child's condition. Where transport assistance is required, the local paediatric team caring for the child should be informed and make the decision as to appropriate patient transport requirements.]

Process for acute transfer to Starship Child Health

Clear communication between the referring, receiving and transport clinical teams is essential. Patient referral and determination of transport requirements are the responsibility of a senior medical officer.

  1. The referring medical team should contact the receiving medical team at Starship Child Health to discuss the referral.
  2. Where the patient is in the Emergency Department (ED) of the referring hospital, the medical staff member who accepts the patient transfer to Starship Child Health is required to ensure the child is suitable for admission to Starship Hospital (age <15 or specific subspecialty contract or current patient of Starship Child Health consultant) and notify the Children's Emergency Department (CED) staff.
  3. Where the patient is a ward inpatient at the referring hospital, the medical staff member who accepts the patient transfer to Starship Child Health is required to ensure the child is suitable for admission to Starship Hospital (age <15 or specific subspecialty contract or current patient of Starship Child Health consultant) and ensure a bed is available by contacting the Clinical Nurse Manager and relevant department charge nurse / shift coordinator.
  4. A verbal handover of patient information between medical staff occurs at the time of referral and a written clinical note outlining key features of history and reason for referral should accompany the patient.
  5. The medical staff member who accepts the patient transfer to Starship Child Health will confirm acceptance of the referral, identify the destination ward (for patients in a ward at the referring hospital) or CED (if patient is in the emergency department at the referring hospital) and confirm the patient transport requirements (see Patient Transport Recommendations above) with the referring medical team.
  6. Where the patient is a ward inpatient at the referring hospital, the receiving nursing team contacts the referring ward to gain a nursing handover and confirm transport arrangements and informs CED staff of the patient transport.
  7. All patients transported from a hospital ED (except if transported by a designated ICU transport team) will be assessed and initially managed in CED. It is anticipated this will involve a combination of staff from CED and the receiving team.
  8. All inpatients transported from a hospital ward (except if transported by a designated ICU transport team) are initially triaged by CED nursing staff.
    1. Any patient assigned a CED triage score of "1" or "2" will be managed initially in CED by the accepting team and CED team and entered on the CHIPS whiteboard. The child will be transferred to the previously assigned inpatient bed once stable.
    2. Any patient assigned a CED triage score of "4" or "5" will be transferred directly to the previously assigned inpatient bed. CED staff will notify the ward of the child's impending arrival.
    3. Any patient assigned a CED triage score of "3" or who the triage nurse is uncertain about, will be rapidly assessed by a CED medical staff member and a decision made to either manage the patient in CED or transfer directly to the ward.
    4. All patients will be reviewed by the receiving clinical team within 1 hour of arrival on the ward, or the inpatient consultant is to be notified.
  9. All patients transported with a designated intensive care transport team:
    1. The intensive care transport team will confirm transport details with the referring ward and destination ward.
    2. Prior to arrival at the destination ward, the transport team should contact staff in the destination ward to update estimated time of arrival and clinical condition.
    3. Accountability for clinical care is transferred to the receiving team when the child arrives at the destination unit. In addition to the referral information handover, a written clinical note of progress during transport is provided by the transport team.
    4. All patients will be reviewed by the receiving clinical team within 1 hour of arrival on the ward, or the inpatient consultant is to be notified.
  10. Accommodation for family/whanau/care giver:
    1. The referring DHB is responsible for arranging accommodation of family/whanau/care giver in accordance with the NZ Ministry of Health National Travel Assistance policy
    2. The receiving ward/unit at Starship Child Health is responsible to ensure that family has accommodation arranged.
      For more information see http://www.health.govt.nz/your-health/services-and-support/health-care-services/hospitals-and-specialist-services/travel-assistance

Hospital to Hospital back transfer from Starship Child Health

Before a child is transported from Starship Child Health to another healthcare facility, the transport process and arrangements for the handover of the child's care must be confirmed between the Starship Child Health clinical team and the receiving clinical team. Accountability for clinical care is an integral part of transport, and remains with the Starship Child Health clinical team until such time as the patient arrives at the destination unit or until a transport team accepts the accountability for clinical care in transit. The Starship Child Health clinical team will confirm the patient transport requirements with the receiving clinical team (see Patient Transport Recommendations above).

Note: Oxygen therapy alone does not imply risk of deterioration. Physiologically stable patients on oxygen will meet level 3 criteria (see Patient Transport Recommendations above) and can travel on commercial aircraft with appropriate healthcare personnel. Oxygen needs to be organized well ahead of time for a commercial flight (see arranging oxygen on a commercial flight below).

Note: Where the transport involves a neonate with a cardiac condition from ward 23B travelling in an infant capsule (car seat), they require an infant capsule (car seat) challenge (see below).

Process to arrange Hospital to Hospital back transport

Refer to:

  1. The Starship Child Health clinical team refer the child back to the receiving clinical team and recommend the appropriate mode of transport (see Patient Transport Recommendations above). 
  2. The Starship Child Health ward charge nurse contacts the receiving ward charge nurse regarding bed availability and handover of pertinent clinical information
  3. The receiving ward charge nurse arranges the transport or asks the Starship Child Health charge nurse to arrange the transport 
  4. The child may be transported by:
    1. Designated air ambulance service (charge nurse calls and makes request; air ambulance service organises plane and personnel)
    2. PICU/NICU transport team (only on a case by case basis following Consultant to Consultant discussion)
    3. Local designated transport team comes and collects patient with appropriate healthcare personnel and age appropriate equipment
    4. Ambulance / transit vehicle or commercial flight service with appropriate healthcare personnel and age appropriate equipment
    5. Ambulance / transit vehicle or commercial flight service unaccompanied by healthcare personnel
  5. Generally only one family member /caregiver can travel with the child; however this may be negotiated

Discharged patient - transport back to home region 

Refer to Patient Transport Recommendations table above (criteria 3)

NB: Where an infant from out of ADHB region is born at ADHB and subsequently requires transport back to their home region, they will need to be registered with the National Travel Assistance for cost of transport to be covered by the child's home DHB (Starship Child Health ward charge nurse to arrange with the social worker).

  • National Travel Assistance will cover travel cost of one parent and support person only.
  • The family are responsible for arranging and paying for travel costs of any other additional family members who have come to Auckland

See National Travel Assistance Scheme for more information

Safe restraint during transport

As health providers, DHBs are responsible for ensuring age appropriate best practice restraint in all vehicles required for the transport including taxis, regardless of legal exemptions.

  1. All children must be restrained in an age and size appropriate travel restraint, suitable for their clinical condition and ability to safely travel in that restraint for the duration of the transport.
    1. When transporting infants in an infant capsule for journeys of greater than one hour, stoppages to allow removal of the infant from the seat should be planned
    2. Neonates and young infants with medical concerns may be considered for a car seat challenge prior to travelling in an infant capsule for a prolonged journey
  2. Refer to section on Infant car seat challenge below
  3. All child car seat restraints must meet New Zealand Transport Agency legislation and standards and displays one of the accepted standards marks (see http://www.nzta.govt.nz/traffic/students-parents/child-restraints.html#safe)
    1. New Zealand Standard 5411
    2. Australian Standard 1754
    3. United States Standard FMVSS213
    4. European Standard ECE44

  4. All child car seat restraints must be correctly fitted into a vehicle as per the manufacturer's guideline. Most child restraints used in New Zealand have an upper tether strap that is clipped onto an anchor point in the vehicle which secures the top of the restraint to the vehicle. This strap must be used for the car seat restraint to be safe for use.
  5. Restraining a child in an ambulance
    1. Currently New Zealand ambulances do not have a top bolt system to enable a car seat restraint to be tethered to an anchor point in the ambulance as per manufacturer's instructions.
    2. When children are being transported on an ambulance stretcher, restraints specifically designed for this purpose must be used. Recommendations:
Infant (< 3kg) Designated transport incubator.
Infant (3-6kg) Consider transport incubator if clinical need to observe infant closely or naked
Ambulance stretcher with Neomate restraint
NB Arrange for loan of Neomate from ADHB Transit nursing service
Infant and child (5-18kg) Ambulance stretcher with Pedimate restraint
NB Arrange Pedimate when booking the ambulance or can be loaned from the Transit nursing service.
Child (> 18kg) Ambulance stretcher with standard restraint

Photos of safe restraint for ambulance transport

Pedimate1
Ambulance stretcher with Pedimate (5-18kg)
Pedimate2
Ambulance stretcher with Pedimate (5-18kg)
Transport incubator
Designated Transport Incubator (<3kg)
Neomate
 Ambulance stretcher with Neomate (3-6kg)

Competency of accompanying personnel during transport

The skill and experience of accompanying personnel are the most important factors in reducing risk during transport. Transport personnel should have the relevant expertise that matches the care needs of the patient; including neonatal and paediatric clinical knowledge, experience and skill as well as transport knowledge, experience and skills. Transport personnel must be trained and experienced in delivering the level of care required for the patient, be able to recognise deterioration in the patient's condition, and must be able to operate safely without the usual clinical backup. Transport personnel should only travel in rotary or fixed wing aircraft if they have completed appropriate aircraft safety orientation.

Refer to Patient Transport Recommendations above.

Transporting Criteria 1 patients (Physiologically unstable or ventilated patient)

These patients require a designated intensive care transport team. The recommended competency of transport personal for criteria 1 patient is as follows:

  1. Minimum
    1. APLS /PALs or equivalent education
    2. Must be capable of managing an infant or child's airway and able to recognize and respond to physiological deterioration of an infant or child.
    3. Must have received orientation and safety education for undertaking transport of physiologically unstable patients.
    4. Completed appropriate aircraft safety orientation (Rotary/fixed wing)
  2. Preferred
    1. Undertaken relevant intensive care course
    2. Undertaken relevant transport training course

*Subspecialty staff may be required to accompany the transport team to stabilize the infant or child before transfer e.g. neurosurgeon, cardiologist

Transporting Criteria 2 patients (Physiologically stable but at significant risk of deterioration)

These patients require personnel with an appropriate level of neonatal or paediatric and transport knowledge, experience and skill. The recommended competency of transport personal for criteria 2 patient is:

  1. Minimum
    1. Paediatric experience and an understanding of age related norms
    2. Working knowledge of transport equipment
    3. Completed appropriate aircraft safety orientation (Rotary/fixed wing)
  2. Preferred
    1. APLS / PALS or equivalent certification
    2. Undertaken relevant transport training course

Transporting Criteria 3 patients (Physiologically stable)

These patients require the parent or caregiver and/or accompanying personnel to have the appropriate level of knowledge and skill to manage the infant or child.

  1. Minimum
    1. Staff member is required for unaccompanied child (< 16 years of age)
    2. Staff member is required for any child at risk of harm to self or others
    3. Staff member is required where nursing intervention or surveillance during the transport is required.
    4. Staff member may be required as an additional support where parent/caregiver needs assistance. However consider if a second family member would be appropriate.
    5. Where no staff member is accompanying, the parents / caregivers must have knowledge of actions in the event of a patient emergency.

Arranging oxygen on a commercial flight

The ADHB does not have a supply of BOC flight cleared travel oxygen packs. These must be ordered on an individual patient basis directly from BOC gases.

The flight must be booked through local hospital travel coordinator, allowing 2-5 days to organise O2.

  • Obtain account details and oxygen purchase order numbers from patient's local hospital
  • Fax a MEDA (medical fitness for air travel) form to Airline (fax number on form). MEDA forms http://www.airnewzealand.co.nz/assets/PDFs/meda-parts-1-and-2.pdf
  • If child has been on commercial flight with oxygen before, please note this on the MEDA form along with approximate previous discharge date as this is helpful for Air NZ.
  • Obtain Air NZ clearance for the child to fly with O2 and permission for BOC to supply O2. Allow ½ day for clearance to occur.
  • Contact BOC ph. 0800 111 333 to order a paediatric transport pack - low / high flow meter (paediatric packs are limited therefore may take a few days). BOC flight cleared travel oxygen packs must be ordered on an individual patient basis from BOC gases.
  • Collect the paediatric transport pack from the designated BOC branch. BOC may be able to courier the pack to the Penrose branch and the family can pick it up on the way to the airport - allow 1 day for courier.
  • Ensure the appropriate checklist is completed by BOC personnel and the pickup up person. The completed form will be required by Air NZ.

Transport equipment available at Starship Child Health

Loan car seats and capsules available for families

  • There are a small number of car seats and capsules available for use by families unable to access their own car seats. These are available for short term loan and transfer situations only. 
  • These car seats are kept at the Starship Hospital Level 2 Information Desk. Available from Monday to Friday, 10am to 4pm; extension 22550. Outside of these hours please call the Transit Care Nursing service; extension 25500. For more information go to - http://www.trauma.org.nz/child-car-seats

Loan equipment for healthcare staff 

  • There is limited equipment available from the Transit Care Nursing service (contact extension 25500) for loan by healthcare staff. For example:
    • When arranging ambulance transfer of an infant 3-5 kg and a Neomate restraint is required 
    • When arranging a local transfer (and return) to an offsite clinic appointment and a Neomate, Pedimate or car seat is required
    • When a receiving hospital transport team has arrived without the correct restraint or equipment
  • When Transit Care Nursing service equipment is loaned a Loan form is to be completed. This confirms that it is the responsibility of the healthcare staff who has borrowed the equipment to ensure the equipment is returned - this includes all courier costs and replacement costs if equipment is damaged or misplaced.

Newborn services

3 intensive care incubator stretchers

Paediatric Intensive Care

2 intensive care incubator and 2 intensive care transport stretchers

Infant capsule (car seat) challenge

A car seat trial will be undertaken on all cardiac neonates and should also be considered for other infants travelling for more than 1 hour without interruption in an infant capsule AND if they meet the criteria as outlined below:

  • Are less than 4 weeks of age
  • Weigh less than 3.5 kg or are less than 37 weeks gestational age (corrected)
  • Have known or suspected airway compromise
  • Have underlying pathology that might reduce capacity for cardiorespiratory compensation (given seated positioning)
  • Have cyanotic heart disease

Infant capsule trials may be undertaken on any infant, regardless of the above criteria if parents request it.  Ideally an infant capsule trial should be undertaken in their own infant capsule (or the one the infant will be transported in).

Positioning for the trial

  • Secure the child in the infant capsule following the manufacturer's instructions.
  • Place the child in the infant capsule with just clothes (no blankets) and then add blankets afterwards.
  • The infant should be secured in the device with the straps done up firmly (you should be able to fit a finger comfortably between the straps and the child).
  • The device should be placed in the same position it would be in the vehicle (i.e. angle of the spine needs to be 45 degrees). You may need to place blankets beneath one end to re-produce this outside a car

Infant car seat challenge Preparing for the trial procedure

  • Choose a time in the day when the child might normally sleep e.g. after a feed.
  • Infant should be constantly observed by carer during trial for changes in colour or breathing patterns.
  • Saturations should be monitored throughout the trial.
  • The trial needs to be 120 minutes in duration, as clinical trials suggest that hypoxic events occur more frequently after 60-90 minutes in a device. If the child is removed before this time the trial should be repeated.

Trial failure would be considered in the event of the following

  • Witnessed apnoea or sudden colour change (with associated desaturation)
  • Saturations dip to less than the agreed minimum for more than 20 seconds
    • For infants with normal cardiorespiratory anatomy this would be less than 92%
    • For infants who usually have lower than normal saturations (e.g. cyanotic heart disease), less than the limit dictated by their physician

In the event of trial failure

  • Discuss need for further investigation with medical team.
  • Consider using an "H-type" insert - repeat the trial with the insert in situ (see picture below).
  • Consider transporting infant flat (travel cot/bassinet/incubator) for transfers or
  • Consider using lie-flat infant car seat in family car.
  • Consider whether oxygen would be indicated.

"H-type" insert

Happi baby car seat
Happi Baby Car Seat insert
Happi baby car capsule
Happi baby car capsule insert

*H- Type inserts can be purchased from most baby product stores or from the Neonatal Trust on level 9 of Auckland Hospital.

** H-Type inserts have not been road tested against current New Zealand Transport Agency standards. However they are currently the best available capsule insert option for neonates who require additional supports in infant capsules during transport.

Additional Resources

Starship Transport Equipment Loan Record

Starship Back Transport Checklist

Starship Transport Form

National Travel Assistance Scheme

  • The National Travel Assistance Scheme provides financial assistance to people who are referred by their specialist to another specialist and need to travel long distances or travel frequently to access specialist care.
  • Where the local specialist (not the child's GP) has referred the child to a specialist at Starship Child Health Hospital, parents may be entitled to financial assistance towards travel and, accommodation costs. The specialist will need to approve accommodation and any specialised transport needs.
  • Transport and accommodation assistance relates to the patient (child) and one support person (a parent or caregiver).
    • For non ADHB families, the child's local DHB funds transport for one caregiver ( 2 for major surgery and when agreed on an individual basis)
    • Other children or family members are not funded so costs must be met by the family
  • The Ministry of Health sets out the eligibility criteria for the scheme and explains how to go about making a claim. For further information, see the Ministry of Health website.

Advice for caregivers - child restraint recommendations

Appropriate car seat restraints - advice for care givers
http://www.nzta.govt.nz/resources/factsheets/07/docs/07-child-restraints.pdf
http://www.childrestraints.co.nz/law.php

Kids Health website
http://www.kidshealth.org.nz/child-restraints-car-seats

NICU parent advice / information
http://www.adhb.govt.nz/newborn/Pamphlets/CarseatsforbabiesA42013.pdf

Financial assistance for Car seat / Capsule restraints

  • Some families qualify and can apply for financial assistance from Work and Income (WINZ) to assist in purchasing a car seat or capsule.

Did you find this information helpful?

Document Control

  • Date last published: 31 May 2017
  • Document type: Clinical Guideline
  • Services responsible: Paediatric Cardiology, Paediatric Intensive Care Unit
  • Owner: Marion Hamer
  • Editor: Greg Williams

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