Provision of intensive care for children

BMJ 1998;317:1320 ( 7 November )

Letters

Provision of intensive care for children

Effective transport systems are essential

Tertiary centres are unproved

Evidence does not support tertiary care

Author's reply

Results of Trent and Victoria study are valid

Effective transport systems are essential

The first 150 words of the full text of this article appear below.

EDITOR $---$ Ratcliffe's recommendations for paediatric intensive care are well supported by the improved outcomes she refers to.¹However, she did not address the reasons why sick children aretreated in small, low activity, and ill equipped units. Thesereasons may seem self evident $---$ for example, community preferencefor local care and the perceived disadvantages of or harm causedby transfer to a distant city.

Community perceptions have to be changed so that best care is seen as preferable to nearby care. This depends on a rapid responsemedical retrieval service with expertise in intensive care thatcan be deployed to the referring hospital quickly enough to createthe impression that the paediatric unit is closer than it actuallyis. This may require retrieval services with a high enough activityto maintain a 24 hour service with medical, nursing, and supportstaff on immediate standby. Our experience is that an activity. . . [Full text of this article]

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Relevant Article

Provision of intensive care for children: Jane Ratcliffe
BMJ 1998 316: 1547-1548. [Extract] [Full Text]

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