Health Department
Planning & Performance Management Directorate

Dear Colleague

NATIONAL PAEDIATRIC INTENSIVE CARE RETRIEVAL SERVICE

This Letter sets out the arrangements for the new nationally-funded service for the retrieval of critically ill and injured children which come into operation on 1 May 2001. The details are given in the Annex.

Action

NHS Trusts should ensure that the new arrangements are drawn to the attention of all staff who may be involved in the decision to refer a child to this service.

Yours sincerely

MR GERRY MARR
Director of Planning and Performance Management

29th May 2001

______________________________

Tel: 0131-244 2420
Fax: 0131-244 2671
E-mail:
will.scott@scotland.gsi.gov.uk

1 . The National Paediatric Intensive Care Retrieval Service will be delivered by transport teams based in the paediatric intensive care units (PICUs) at the Royal Hospitals for Sick Children, Edinburgh, and Yorkhill NHS Trust, Glasgow. This service will secure the delivery of intensive care support to children throughout Scotland, irrespective of location.

2. The new arrangements fulfil recommendations made in the report of the Acute
Services Review (1998) and the Scottish Paediatric Intensive Care Audit (1999).

3. In the last decade, the paediatric intensive care units in Glasgow and Edinburgh have
developed to provide intensive care and transport for critically ill children, but this service could not always be guaranteed, because of pressures either on staffing or on beds. The new national arrangements for the transport of critically ill or injured children will ensure the availability of two transport teams and 2 mobile paediatric intensive care beds for each team. The provision of a National Retrieval Service will also ensure that critically ill children are expeditiously transported by experienced medical and nursing staff and receive complex critical care in one of the two national centres. This initiative is part of the Executive's ongoing programme of developments to promote excellence in Scottish child health care through the concentration of specialist services in expert centres.

4. The Service will operate on the premise that individual patients will be resuscitated and stabilised at the site of presentation by senior hospital staff, and that the retrieval team will be dispatched following discussion between the receiving intensive care consultants and the referring consultants or, exceptionally, other doctor. The transport team will consist of a senior paediatric intensive care doctor and nurse, who would transfer the child to the paediatric intensive care unit for appropriate care.

5. The pivotal discussion prior to patient transfer will be between the receiving and the referring consultants, and the normal practice would be for each transfer team to retrieve to their own unit. However, in exceptional circumstances, demand for intensive care beds may require that one retrieval team transports a patient to the other unit. There will also be a requirement to transfer children to supra-regional centres for specialist care such as liver or heart transplantation, or for extracorporeal support.

Transport Procedure

6. Consultants who wish to refer a critically ill child for transport should contact the consultant on duty for PICU in either Edinburgh or Glasgow according to the usual referral patterns. The receiving consultant will determine whether the child's condition warrants and is fit for transfer; will ascertain bed and transfer team availability; and will advise the referrer of the PICU to which the child will be transferred. The receiving consultant will discuss measures for stabilisation of the child until such time as the team arrives, notify the ambulance service of the transfer, and organise the transport fellow and nurse for the retrieval. A referral protocol is set out below.

Referring Hospital

• Referring consultant contacts duty PICU clinical fellow (details taken)
  

Receiving PICU

• PICU fellow completes the patient transport form and contacts the duty PICU consultant
  
  
• Consultant discusses the transfer with the referring consultant, including interim management
  
  
• PICU charge nurses and ambulance service notified and transport team assembled
  
  
• Contact maintained with the referring hospital
  

Neurosurgical Transfers

• If the patient requires rapid neurosurgical intervention (eg extradural haematoma), it may be necessary for senior staff from the referring hospital to undertake the primary transfer
  
  
• If urgent intracranial decompression is not required the transport team may be utilised for transfer
  
  
• CT scanning with transmission of images will facilitate the management and transport of children with head injuries.

7. The allocation under these arrangements of 2 paediatric intensive care beds to Edinburgh is part of the Executive's determination to underpin the viability of the PICU there, and includes further strengthening of key specialist services such as paediatric cardiology and paediatric nephrology, both of which involve clinical networking between Edinburgh and Glasgow. These moves reflect the Executive's commitment to the model of paediatric intensive care advocated by the Scottish Paediatric Intensive Care Audit of 2 PICUs in the central belt providing the full spectrum of care.

Transitional Arrangements

8. Rapid transition to the national service has been made possible since the service has been running already on an informal basis in both Glasgow and Edinburgh. The formal introduction of the service from 1 May 2001 nevertheless recognises that it will take some months longer for the full quota of staff to be recruited. The transitional period from the current systems in Edinburgh and Glasgow will be about 6 months, as new staff are unlikely to be in place before 1 August at the earliest, and there will be a 3 month training period after that.