Effective transport systems are essential

EDITOR—Ratcliffe's recommendations for paediatric intensive care are well supported by the improved outcomes she refers to.1 However, she did not address the reasons why sick children are treated in small, low activity, and ill equipped units. These reasons may seem self evident—for example, community preference for local care a community perceptions have to be changed so that best care is seen as preferable to nearby care.This depends on a rapid response medical retrieval service with expertise in intensive care that can be deployed to the referring hospital quickly enough to create the impression that the paediatric unit is closer than it actually is. This may require retrieval services with a high enough activity to maintain a 24 hour service with medical, nursing, and support staff on immediate standby. Our experience is that an activity of over 1000 retrievals a year is needed to meet this goal, which may mean having regional retrieval services acting for several paediatric intensive care units rather than one for each unit. The service must have dedicated ambulances to minimise delays. Regional services can deploy teams independently of staffing constraints on a particular unit yet can form close links with units to maintain professional standards and expertise.

To avoid another child dying in transit any new system would have to include a “teletriage” process offering immediate telephone access to senior clinical advice. It would also need the collaboration of relevant clinicians and ambulance staff to ensure that care before transfer was appropriate and that a management plan was devised (including the optimal destination).

Successful regionalisation of paediatric intensive care depends on an effective and responsive infrastructure for transporting patients. The infrastructure must be developed around the needs of the referring hospital and the patients; it should launch teams to patients regardless of shortage of intensive …