Section 9 - Transportation

Purpose: These recommendations suggest the appropriate procedure for the transportation of pediatric patients following a disaster. The section presents guidelines for both inter- and intra-hospital transport of stable and unstable pediatric patients. Pediatric patients may not always be accompanied by an adult during a disaster; therefore, these patients will require additional staffing and supply needs during their transport.

Section Contents

General Guidelines:

All hospitals need to plan for the potential necessity of delivering extended care to pediatric patients during a disaster. As part of this care, patients will need to be transported from clinical area to clinical area (including inpatient units) or to diagnostic testing (such as radiology, CT scan, and ultrasound). For those centers without specialized pediatric services, transfer of pediatric patients (after initial evaluation and stabilization) to a center with advanced pediatric capacity might be desired. However, transfer might not be possible due to local conditions and safety concerns, lack of appropriate transport vehicles and personnel, and/or lack of capacity at the usual pediatric resource hospitals.

Transport of Pediatric Patients within the Hospital

General guidelines for transporting pediatric patients between hospitals units or diagnostic testing areas

I. Transport personnel:

  1. Personnel to transport stable patients
    1. All transport personnel should be oriented to the special needs of a pediatric transport.
    2. Pediatric patients may not be left alone at any time.
  2. Personnel to transport unstable patients
    1. Use usual transport personnel.
    2. Additional staff skilled in pediatric airway management and familiar with pediatric resuscitation will be necessary.
    3. Pediatric patients may not be left alone at any time.

II. Transport equipment:

  1. Have airway management and resuscitation supplies available, which are appropriate for all age groups. (See Section 11-Equipment Recommendations.)
  2. Identify appropriate transport vehicle(s):
    1. Adult stretchers may be appropriate for children >8 years old.
    2. Smaller children may require a crib, additional transport personnel, and /or converting an adult stretcher by adding padding to the inside rails to assure safety during transport.

III. Chaperone and safety personnel:

  1. Parents or adult caregivers should be encouraged to stay with children.
  2. If no adult caregiver is available, appropriate personnel must accompany and supervise pediatric patients to assure their safety at all times.
  3. Patients on stretchers
    1. Patients less than 6 years old and not in an appropriate crib require continuous 1:1 observation.
    2. Patients 6 years old and older should be evaluated for ability to follow safety rules while on the stretcher.
    3. Individual patients separated from other pediatric patients require constant 1:1 observation by staff.
  4. Stable ambulatory patients may be cohorted in a Pediatric Safe Area with staff experienced or trained in observation of groups of children, such as schoolteachers, social workers, or day care workers. (See Section 5-Security.)
    1. All ambulatory patients transported individually out of the Emergency Department require 1:1 adult supervision.

Transport of Pediatric Patients from the Hospital to Other Facilities

During a disaster, local conditions might preclude safe or efficient travel on the streets or highways or the usual pediatric receiving centers might be overwhelmed with patient volume and unable to accept transfers. Therefore, all hospitals must be prepared to provide emergent and continued pediatric care.

Even in the event that transfer to a pediatric center might be possible, the usual mechanisms for interhospital transfers should not be relied upon because these staff and equipment will be utilized to respond to the actual disaster. Therefore, hospitals should consider alternative mechanisms for safe pediatric transfers.

I. Stable Patients

  1. In accordance with NYS regulations, arrange for car seats if appropriate. (See Table 9.1.) Potential sources for appropriate car seats:
    1. Purchase or obtain through donation.
    2. Identify local sources of car seats in case needed.
    3. Survey employees to determine availability of car seats in employee vehicles.
  2. Identify appropriate transport vehicles if an ambulance is not available:
    1. Cars or vans may be appropriate for children who can sit up (car seats may be necessary).
    2. The driver must be able to communicate via cell phone or radio with the hospital emergency command center.
    3. If available, appropriate medical personnel should accompany patients during transport.

II. Unstable Patients or Potentially Unstable Patients

  1. Identify an appropriate transport vehicle
    1. Ambulance with Emergency Medical Technician (EMT) or Paramedic augmented with:
      1. Hospital staff skilled in pediatric airway management and resuscitation.
      2. Equipment appropriate for the age and acuity of patient.
    2. Consider entering into a Memorandum of Understanding (MOU) with ambulance providers at distant locations who are less likely to be involved with local disaster response.
  2. Specialty pediatric transport teams from referral pediatric institutions.
Table 9.1-Appropriate Use and Type of Car Seats
  Infants Toddlers Young Children
Age & Weight Up to 1 year old AND 20 lb or less Over 1 year to 4 years old AND between 20 lb and 40 lb Ages 4-8, less than 4'9" AND over 40 lb
Seat Type Infant only or rear-facing convertible Convertible or forward-facing Belt positioning booster seat
Seat Positioning Rear-facing only Forward-facing Forward-facing
Caution: All children age 12 and under should ride in the back seat.