> THe clinical governance for retrieving ill children to PICU
> centres for
> treatment are in overwhelming favour of such teams. There is
> evidence that
> experienced and properly trained teams produce a lower morbidity.
> References - Britto et al BMJ  1995

Although Britto's paper just showed that in their sample of 51 patients
there hadn't been any problems; not that the patients did any better than if
they had gone by taxi (not that I'm disagreeing with your point- just that
this in an academic list so the actual quality of evidence is important).
Interestingly, the paper also stated in its introduction that critically ill
children do better in paediatric ITUs whereas the CRD systematic review
showed the opposite. The other paper you may come across is from around 1990
by Julian Bion (can't remember reference). Although in its abstract it
stated that children do better when transferred by experienced and properly
trained teams; if you look at the data it actually shows that the sicker
children are to start with the more likely they are to be transferred by an
inexperienced team.
However, regardless of the quality of the evidence, I think we can safely
say that if a patient needs an intervention prehospital it is best done by
someone who is good at doing it. I think the lack of evidence stems from
either difficulty in doing the research or prehospital/ in transit
interventions being inappropriate.
Either send experienced and properly trained clinicians or send a good
driver with a fast vehicle and scoop and run depending on which side of the
fence you fall on.
Anecdote: While an SR in a hospital with no paeds facilities I had a sick
child with meningococcal sepsis. Called local paeds centre who told me to
send the child with an escort. Difficulty persuading them that if we had
anyone appropriate to escort the child we wouldn't need to send them.

Matt Dunn
Warwick


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